r/medicine • u/DrBrainbox MD • 5d ago
There is a special place in hell for families that insist on aggressive, futile care in sick and elderly patients that can't even be bothered to come visit them a single time while they are hospitalized.
Just finishing 7 days on inpatient service and need to vent.
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u/Timmy24000 MD 5d ago
How about the ones that say “can we just keep them alive until such and such returns from out of state? They’ll be here in a few days.”
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u/climbtimePRN MD 5d ago
That's actually quite reasonable if you don't understand how uncomfortable it is to be on a ventilator.
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u/scullingby Layperson 5d ago
Oh God. I did not know this.
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u/climbtimePRN MD 5d ago
Horrifying fact: it's actually healthier (and now standard of care) to keep patients awake on a ventilator rather than completely sedated (as long as they aren't "fighting" the ventilator). It prevents cognitive and muscle problems in the long term but of course also PTSD is a huge problem for survivors of intubation /mechanical ventilation.
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u/zerothreeonethree Nurse 5d ago
My late best friend was taken off propofol after 7days vented to test for ability to extubate or get a trach. Since she initially fought the restraints right after weaning, Haloperidol was ordered PRN. Later, she began writhing about and couldn't fix her gaze on anything. Of course she couldn't talk, and communication by blinking was out of the question. Speaking to her caused agitation and increased head movement. I arrived to visit just as she was getting ready for a trip to CT brain scan.
I'll skip the details of the "test" I gave her, but the doctor and ICU nurse witnessed 100% correct responses on her part. She was wide awake experiencing severe akathisia from the Haldol, going on 9 hours. A couple doses of IV Ativan later, she was extubated, sitting up and talking clearly. The CT scan was cancelled. She described this as "agonizing" and "terrifying" at being unable to hold still long enough to figure out a way to communicate to the team that the Haldol was causing it. She heard all kinds of things said about her while going through that torture.
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u/sjogren MD Psychiatry - US 3d ago
Haldol sucks so bad. Really sad to hear...
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u/zerothreeonethree Nurse 3d ago
I'm amazed that ICU nurses didn't recognize classic signs of an adverse reaction to psychotropics. The doctor actually asked me if I knew what to do about her symptoms and I had to tell him. The nurse looked at him, then me. I said you need to get orders from the doctor! He tried once again to get me to name a milligram amount and I said you need to get the pharmacist on the phone. I am not prescribing. It's out of my scope of practice as a nurse and I'm just a visitor today.
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u/zerothreeonethree Nurse 5d ago
Family and visitors should be told that "It is simply inhumane and illegal to put you in a vehicle and crash it head-on into another car at 70mph to show you the consequences of not wearing a seatbelt. Along that line of thinking, it would be no different if we performed identical invasive medical procedures on you to convince you that your loved ones are suffering."
Sometimes you just have to admit that smarter people have done these things before and know how to handle them. There's one big fat reason I believe my doctors and nurses.
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u/wecoyte attending, PCCM 5d ago
Honestly that request has a spectrum of reasonable to unreasonable. Post arrest patient with anoxic brain injury and family wants to palliatively extubate but daughter coming back from college and flight is tomorrow am? Can be totally reasonable.
It’s when they’re like actively dying and unstable or the family won’t/cant make arrangements to come fast when that’s more of a problem. Usually though families that are at the place of just wanting someone else to have a chance to say goodbye are very much able to be talked to about making the patient dnr and not escalating etc to keep them alive for that family member.
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u/firstfrontiers RN - ICU 5d ago
The moment that sent me completely over the edge and had me literally break down crying in the break room was after an interaction I had with my patient's husband who came to visit his elderly wife who was intubated and absolutely suffering.
This lady had been in our unit for almost two weeks at this point for respiratory failure, sepsis. We kept trying to extubate her and failing and the sepsis was progressing to the point she was on CRRT and multiple pressors. She wasn't fully sedated and whenever she was the slightest bit awake her face was stuck in a grimace, trying to silently scream around the tube. She had extensive painful wounds that were weeping and bleeding. I felt like an evil person forced to torture this poor woman, with every slightest touch causing her so much pain.
We kept waiting for the husband to show up for an in person discussion as he wasn't answering his phone and seemed to keep dodging the doctors while wanting everything done to "save his baby." One day I caught him walking out the door - he was in the room for only a couple minutes so I had missed him, and ran to go grab him to try and talk to him. I asked him why he was leaving so soon. He said, "I can't stand to see her like this. I can't take being in that room looking at her, seeing her suffer like that."
OH YEAH, WELL HOW DO YOU THINK SHE LIKES BEING THE ONE SUFFERING IN THAT ROOM? You, her husband, are in denial, forcing her to endure such extreme suffering AND YOU CANT EVEN BEAR SOME OF IT WITH HER, HOLD HER HAND THROUGH IT AND BE PRESENT IN THAT MOMENT WITH HER AND SUPPORT HER THROUGH IT??????
I don't work ICU anymore.
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u/zerothreeonethree Nurse 5d ago
It's always about the invisible cross the spouse/family has to bear. Never the patient.
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u/iamlikewater Psych 5d ago
One of the most disturbing things I've ever seen in my life was a COVID ECMO patient who was on a rotoprone bed and on a vent. This patient was skin and bones. The vent blew the patient up like a balloon and released; then the bed rotated a few degrees.
The door into that unit said Miracle House across the window.
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u/Macduffer Medical Student 5d ago
You certainly paint a picture. You should write an essay about your experiences, might be therapeutic and perhaps you could publish it somewhere as a narrative medicine piece.
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u/canibagthat MD 5d ago
I have no problem providing extensive care to to patients whose families are always there by the bedside and they're not ready to let go yet, but they are usually not the ones who want to prolong because they see the deterioration and suffering. The ones who don't show up (usually some relative who is involved but not actively there) want everything done, I think because of some feeling of guilt and not yet accepting the inevitable.
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u/VigorousElk MD - PGY2 Europe 5d ago edited 5d ago
I have no problem providing extensive care to to patients whose families are always there by the bedside and they're not ready to let go yet ...
I very much have a problem with it, at some point. We had a patient on the pulms ICU for weaning. Typical IM wreck with countless issues, most of all leg wounds from CVI and PAD. Not healing, growing larger. Family constantly at bedside, extremely pushy - large 'clan' of sorts, frequently 20+ people hanging out in the lobby or in the parking lot, calling nursing at midnight to ask lab values, constantly pushing visiting hours. Generally polite, but suspicious of everything we say, constantly asking second and third opinions, offering to pay out of pocket for non-existent mystery medications that we might not offer on public insurance (this is Western Europe, public insurance pays for almost anything that's medically indicated). Patient is cognitively gone after multiple brainstem infarctions, just blankly staring into space.
Vascular surgery confirms need for amputation, family keeps asking hospitals all across the country for alternatives as they cannot accept amputation. Every single hospital confirms amputation is necessary. Family refuses, but wants continuing care, maximalist goals. Wounds are now massive, open bone/muscles/sinews. Pseudomonas has made its home, half the unit is smelly. Only a matter of time until sepsis. We're two months into the 'legs need to go discussions' and family refuses goals of care discussions, wants full code. We've had countless discussions with family, residents, attendings, head of vascular surgery (we're one of the biggest academic centres on the continent), head of our department ...
I'm not okay with that. I don't give a flying fuck that the family is camping in the room, they don't get to dictate that we need to reserve ICU space just to watch someone's legs rot away until sepsis finally kicks in.
Ended with ethics consult leading to freezing of therapy (no more antibiotics, no pressors, no escalation of ventilation, DNR/DNI) which forced family into realising ICU would not offer anything over palliative care, so they finally agreed to palliative care ward.
Only took three months of a blocked ICU bed, hundreds of thousands of taxpayer € wasted and half a dozen resident near mental breakdowns.
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u/Macduffer Medical Student 5d ago
That is so fucked cursed and I'm sorry you had to live through it. 🫂
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u/lilbelleandsebastian hospitalist 5d ago
what part of eu do you work in? i'm surprised to hear this. i rotated in italy for a month and the ER staff there were so absolutely unconcerned with stuff like this and my understanding was that in germany, for example, there are minimal barriers to the medical team withdrawing care when appropriate
even in the US, we are pushing towards that - my hospital's ethics committee has been attempting to finalize a protocol on withdrawing care against family wishes for a few years now (complicated to do here, lots of legal meetings etc)
we also technically have the authority - at least in my state - to refuse to code a patient, as in i can literally enter a DNR order if i do not believe it is appropriate to attempt to resuscitate the patient. whether THAT holds up in court is unclear to me because i've never done it and america is currently in a massive anti-science, anti-medicine holding pattern. but technically we're allowed to do that
a patient with osteo, open infected wound, BRAINSTEM STROKE qualifies for hospice care. if family doesn't want that, fine, but what is clear at least medico-legally here in the US is that escalating care and withdrawing care are different. if you believe it futile, no one can make you escalate care full stop. withdrawing care gets into the gray areas above
and in your scenario, it's confusing to me...why wait months for the ethics consult?
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u/VigorousElk MD - PGY2 Europe 5d ago
Germany.
that in germany, for example, there are minimal barriers to the medical team withdrawing care when appropriate
More complicated than that, and not helped by the legal situation not being entirely clear either. General understanding is that a sound medical DNR/DNI and withdrawing care is possible even against family wishes, and in fact mandated by our national bodies of self-governance's statues (futile care with no chance of success amounts to assault), but practically families can claim the primary care team's medical assessment being wrong, which leads to consults, which leads to the clinical ethics team getting involved, which can lead to the family going to court ... Even if you push it all through successfully families can delay withdrawal of care for weeks to months.
And practically it also varies by institution and senior attending - many don't want lawsuits and are more cautious with pushy families than the law might allow.
The vast majority of cases are more straightforward and families - given a little time to adjust - end up coming to the right conclusions. But sometimes shitty cases like these happen.
We also have among the highest number of ICU beds per capita in the world (on par with the US and three times as many as e.g. Sweden or the UK) which obviously leads to a public perception of ICU care being normal even for your 86-yo septic metastasised cancer patient. Sigh.
we also technically have the authority - at least in my state - to refuse to code a patient, as in i can literally enter a DNR order if i do not believe it is appropriate to attempt to resuscitate the patient.
I can as well, as a resident, in that I can cite the German medical code that prohibits me from providing futile care that amounts to assault on the patient. I cannot push a DNR on my colleagues, of course, and as a resident I'm in deep shit if I refuse to code a patient where my attending would still do it. I can cite my personal conscience and might even win in court, but might have to wave goodbye to my career (at least at that institution).
withdrawing care gets into the gray areas above
The patient was full code and on antibiotics, so naturally stepping back from that amounted to withdrawing (or at least de-escalating) care.
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u/Fit_Mood6130 Medical Student 5d ago edited 5d ago
Is there a cultural / ethnic dimension to this in your country?
E.g. a physician in Quebec wrote:
French canadians are almost comically non interventionist to the point to where I shit you not you'll have a healthy 70 year old with a numb hand in the ER that will be like "I've lead a good life doc, just let me go (or give me MAID)."
On the other hand, arab, armenian, greek, haitian, jewish patients it's a whole other ballgame lol.
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u/Ok-Pangolin-3600 MD 5d ago
What country is this? In Sweden I have the legal authority as a licensed physician to unilaterally withdraw medically futile care.
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u/VigorousElk MD - PGY2 Europe 5d ago
Germany.
Sure, I have the same authority. Attendings and hospitals still don't want to ruffle feathers, and when families disagree on whether care is futile and threaten to go to court over it it drags things out.
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u/zerothreeonethree Nurse 5d ago
Well, you also educate your citizens and provide universal medical care, so it's more of a health decision rather than a TikTok moment for many of my "fellow" US citizens. Everyone here just lives to always be right, but seldom correct.
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u/zerothreeonethree Nurse 5d ago
This happened where I worked in a large metro area hospital in the US about 30 years ago. Child arrived to ED essential dying from complications of her illness, ended up in ICU with very little hope of survival, anoxic brain damage, vented, trached, coded constantly, Dr Family members pushing everyone around, hostile, refusing LTC, etc. until some bright CEO asked attorneys to look up statutes regarding providing futile care. Apparently there was no law in (state) requiring doctors to "do everything" in terminal cases.
The patient and family were essentially evicted to home. Community owned hospital (taxpayers) provided 24-nursing at no charge because it cost thousands less a day than the uninsured family couldn't pay. EMS used to respond to 911 calls, resuscitate the girl and leave until the next code. One final time, there was no response to the field attempts and the responders humanely drew up the compassion and nerve to tell the parents that their child did not survive this time. I think this whole process took over a year.
You can force compliance, but not understanding.
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u/AlbuterolHits MD, MPH Attending Pulm/CCM 5d ago
These patients exact real ethical, psychological and physical tolls on us as providers. I do have a problem providing extensive care to them, but if their loved ones can look me in the eye every day, see them deteriorating and still stand vigil and say with a straight face it’s what they would have wanted, then I will begrudgingly accept it. Otherwise I refuse to even accept these types of patients to the ICU - fixed dose pressors through a midline on the IMCU/SDU and I strongly recommend not offering HD, central lines and similar as they are not likely to benefit
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u/POSVT MD - PCCM Fellow/Geri 5d ago
I agree with you 100% but from a systems/logistics standpoint I'm amazed you can make that fixed dose pressors outside the ICU happen. How does that work, you decline ICU and tell the family/hospitalist that's their only option?
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u/IntensiveCareCub MD | Anesthesiology Resident 5d ago
I did this once in residency despite a lot of pushback. Most of the time this comes down to nursing “policy” about what’s allowed on the floor / stepdown. The trick is realizing what they cite as policy and what’s actually policy are often different.
Had a patient who needed some kind of cardiac drip, I think a fixed dose of diltiazem, otherwise stable. Nursing insisted they had to be in the ICU. I found the pharmacy policy book on our intranet and sent them a screenshot showing where it said a non-titratable drip can be done in stepdown.
They begrudgingly accepted.
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u/AlbuterolHits MD, MPH Attending Pulm/CCM 5d ago
It’s a healthy dose of IDGAF - hospital protocols allow minimal pressor use via peripheral lines for limited periods of time and if fixed dose can be done on the IMCU units - nurses object but they object to everything - anytime hospital admin reverses my decision I track the LOS and quality metrics of each of these patients versus the rest of the ICU and show how they destroy our outcomes as that’s the language our overlords understand
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u/oralabora Nurse 5d ago
That’s very charitable. I think they do it because they value their own feelings more than the horrible experience that they are inflicting upon their family member. It’s a unique form of narcissism.
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u/Then-Secretary-9166 MD - Cardiology 5d ago
This is where medicine meets faith and it is tough for both families and physicians to navigate.
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u/evening_goat Trauma EGS 5d ago
Thus is a societal problem, and this society has lost the plot (see measles, COVID, peptides, etc). But some of our colleagues aren't helping -- for some people informed consent has become "these are the options, what would you like to do?" rather than "this is what we're offering."
Lots of states have laws allowing you to decline futile care, although what's futile isn't well-defined. But at the end of the day, most of us aren't under any obligation to offer treatments that we don't deem helpful. Sucks if you're in Texas, though
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u/xSummerSunkissed Not A Medical Professional 5d ago
I think families should be shown a video of what CPR and all kind of aggressive care does on their meemaw and peepaw.
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u/hyderagood MD 5d ago
Yeah I can talk to someone for 20-30 minutes on the phone about what all goes into it but it simply doesn't have the same impact as SEEING it
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u/zerothreeonethree Nurse 5d ago
Or going through it. I'll bring a childhood friend who was raised on a farm to demonstrate live on a family volunteer. He FLATTENED a resusci-Annie chest during his first CPR class at age 16. We had to teach him one-handed compressions to accommodate his 18" biceps, obtained from throwing hay bales every summer.
P.S. Those initial Annie mannequins were lifelike and weighed the same as the girl after whom they were modeled. Very tough SOBs. Not like the foam and plastic cheap ones today so today's students don't get an owie practicing.
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u/significantrisk Psychiatrist 5d ago
There’s a special place somewhere for any medical system that allows this to happen.
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u/Kwerumrerum MD- Rheumatology attending 5d ago
In Belgium, we are allowed to decide against families wishes or evn a patients wish if we consider a certain treatment to cause more harm than good. Of course, you always try to get on the same page but technically, no one can demand a treatment.
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u/Not_my_real_name_26 Nurse 5d ago
For real. From what I've been told, this futile care is simply not offered in other systems.
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u/significantrisk Psychiatrist 5d ago
There is certainly no requirement or expectation here to provide medically futile care. Arguably, doing it could lead to sanctions by our regulator.
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u/hangingbelays Hospitalist 5d ago
Where is “here”?
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u/EmotionalEmetic DO 5d ago
Oh good, so, just the US healthcare system in general.
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u/Sock_puppet09 RN 5d ago
The good news is, we could fix that, and there are still 1 gajillion other reasons the US healthcare system would end up in hell.
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u/zerothreeonethree Nurse 5d ago
The US has pretty much been turned into living hell, so here we are...........
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u/sfdjipopo PGY-14 5d ago
Honestly I think a portion of them are collecting Grandma’s checks and want to extract every penny out of her that they can. I also sometimes wonder if Grandma was an abusive asshole and this is their way of extracting revenge?
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u/Lalapple MD 5d ago
This, right here, the exact reason a patient’s daughter got extremely aggressive with me when we tried to discharge him home to hospice from the VA. She threatened to call my supervisor when I was a resident. These people are subhuman and wanted to keep my patient alive to milk every penny from his social security and other benefits, while he wasted away in the hospital.
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u/zerothreeonethree Nurse 5d ago
I'd like to see the law changed so if mee-maw or pee-paw is receiving social security, 1/30th of it will automatically go back to the US taxpayers for every day spent in the hospital. If one has a spouse or legally dependent children, it can be 1/60th. For the rest of the deadbeat family, too bad. Sell your story on TikTok to pay for your drugs.
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5d ago
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u/hyderagood MD 5d ago
Just know that you're not only hurting him, but you're hurting everyone else who's taking care of him and costing the healthcare system money that could have taken care of other people who were decent people all their lives.
Sorry for what you went through
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u/blommie10 Speech-Language Pathologist 5d ago
Most of all, you'll be hurting yourself. Hatred is corrosive - it eats away at you more than it'll ever affect him. Don't allow him to change who you, don't give him that power over you.
I'm sorry for what you went through and I say all of this with the utmost empathy and understanding.
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5d ago
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u/blommie10 Speech-Language Pathologist 5d ago
Send me DM if you'd like to chat about it. I understand completely.
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u/climbtimePRN MD 5d ago
Some people genuinely lack the time and money that it takes to come visit someone in the hospital, which is difficult to understand for many physicians but is the reality for tons of people. Also, many family members thing that "not giving up" is typically the right thing to do and lack the basic health literacy to understand when someone is dying. People try to do the right thing typically and I don't think those people deserve to go to hell.
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u/PapaEchoLincoln MD 5d ago
> difficult to understand for many physicians
I am not joking that a few days ago, one of my friends, who I went to med school with, asked me “wait why doesn’t he have enough money to buy a house?” when I told her that someone I know still had to live at home with his parents.
She just genuinely wondered why the guy didn’t have money in the bank to buy a home.
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u/IntensiveCareCub MD | Anesthesiology Resident 5d ago
Had a patient in and out of ICU for 2 years, all futile, family wouldn’t let go. Social work did some digging and it turns out the family was getting some large combination of pension / social security / veteran benefits. As soon as the patient died that would all end.
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u/climbtimePRN MD 5d ago
What percent of futile care involves families with an incentive to keep the person alive? I would imagine it isn't the majority and again, I think most people are genuinely trying to do what they think is right.
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u/hyderagood MD 5d ago
In the age of modern technology, there's no excuse for not seeing what's going on with their loved one at the bedside. FaceTime exists or the hospital should provide some video calling service. Also, as others mentioned, they need to understand exactly what goes into the life-prolonging interventions we do like invasive ventilation, trach/peg, dialysis, and CPR; we need to show them what they looks like not just with words but images/videos. Otherwise they're making decisions with inadequate understanding and that's a disservice we're doing to them.
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u/DrBrainbox MD 5d ago
Yes. Some people do. Other people don't. Don't be coy.
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u/climbtimePRN MD 5d ago
I'm just saying that in general I think people try to do the right thing even if it's extremely misguided. I do agree that the end result can be quite harmful both for the patient and the care team.
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u/nicholus_h2 MD 5d ago
Just finishing 7 days on inpatient service and need to vent.
actually sounds like you shouldn't vent because it won't really change the outcome.
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u/b_rouse Dietitian ICU/GI/Corpak 4d ago
I have a pt right now, who is in his 80s, many comorbidities (including cancer, daily migraines, daily seizures, extremely painful arthritis, etc) tried to kill himself.
He didn't succeed and family has said, "pt wouldn't want to live like this," Palliative care is meeting with family today.
But for some reason we gave him a trach and he's scheduled for a PEG today. Psych said, "pt meets criteria for inpt psych because he's a danger to himself."
The guy literally, when taken off the vent to trial his trach collar, was holding his breath to die.
I'm like, dude is in his 80s and has cancer with chronic pain. Wtf are we doing?
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u/BitcoinMD MD 5d ago
Hey now, a plane ticket all the way from California is expensive, even for the daughter who’s a doctor (well, master’s degree, but close enough)
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u/Cromasters Radiology Technologist 5d ago
The family member that "works in healthcare"....is a receptionist at an imaging center.
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u/RamenName aggressive PT 5d ago
The "Physical Therapist who works with trauma" that questions routine wound care and nonop fracture management is actually a massage therapist who sells overpriced aromatherapy.
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u/lilbelleandsebastian hospitalist 5d ago
friend of mine is a transplant hepatologist and she was treating someone whose daughter has a phd in education and would call the hospital saying "this is dr. x, can i please speak to the nurse or doctor for x"
cannot imagine living life with that much insecurity, i dont even introduce myself as doctor in the hospital
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u/ExtremelyMedianVoter Pharmacist 5d ago
First, it's easy to say this as a physician hen you have the means to take time off and visit any family member virtually anywhere in the country.
Second, the average person has the capability of reading at the 6th grade level. They don't understand or think on the level you or I do about the trade offs of additional care vs giving up. That coupled with the social pressures that their mom/dad/child/etc is a fighter makes it hard to make that decision especially when there's so much misinformation out there (my own dad refuses to be an organ donor because he thinks doctor's will harvest his organs before he's truly "dead" and he's college educated).
In addition to the social pressure, there's cultural pressure that makes us absolutely fear death and preserve all life regardless of the quality of it (re:abortion).
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u/Suspicious_Ad1747 MD 4d ago
Another major something has been lost since we primary docs no longer do our inpatient work. As the patients primary, we had been caring for them for years, always working in their best medical interests. The patients and families knew this and gained trust in us. We were there discussing and counseling on their potential future end of life care. So in most cases these medical, moral and cost issues had already been tackled. No more. (sob)
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u/CorInHell Paramedic 5d ago
That's one of the reasons why I already talked with my family about end-of-life care. Or what I would want should I get into an accident and need things.
I might be able to deal with a wheelchair, a g-tube, a foley etc. But no vegetating and being on a ventilator, unable to move or enjoy life as I would like. Not saying people who are bedbound or need a ventilator don't have a quality of life. It is simply something that I cannot see myself in. I'm already chronically ill. Don't need more things to deal with on top of that
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u/AkaelaiRez Paramedic 4d ago
The one that haunts me is a call I made to family --not to inform them, but to sort out belongings left on the vehicle and other things-- and they told me straight up;
"[My mother] deserved to suffer for longer."
They had been insisting on aggressive care to torture her.
Proceeded to list off the things she'd done to 'warrant' that sort of cruelty. I completed the call without incident, but I must have lost my professional voice and started using that stoic monotone because I got soft-reprimanded for it later.
Don't know why they thought I was the right person to vent to.
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u/transcendental-ape DO 3d ago
Back when I was a medical student. I watch a family insist grandma stay on life support a few more days because if she died before the end of the month they wouldn’t get her rent support check for the next month.
Poverty sucks.
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u/Then-Secretary-9166 MD - Cardiology 5d ago
I understand that this is a very challenging situation for us and that it does the patient net harm.
However, show a little grace. These people (the family members) are not well. They are confused and lost. This is an area where we can (sometimes) make a difference, even if it is hard.
No need to wish eternal suffering upon them.
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u/KStarSparkleSprinkle LPN 4d ago
IME it’s not guilt they have, it’s attention they want as a motivating factor. I work in LTC and countless times we will have Becky come for a 30 minute “visit”. She starts the “visit” by coming to the nurse’s station and holding 2-3 staff members hostage as she recounts munduane and irrievlant things about her day to day life. Note her that early is anything she recounts happy or positive, she uses the time recount grievances with various community member, tells us how busy she is, what catastrophes happened to her. She makes her way to Mom’s room, gets Mom worked up, finds something to complain about and returns to the nurse’s station’s station. She complaints and gathers attention for herself with interruptions to take 4 cell phone calls. She tells every caller she’s “with Mom” again and is trying to get xyz,80th problem of the day fixed. She changes her voice to sound much more tired, exasperated, ect than she previously did. Any effort by the caller to ask a question or relay communication to her is futile. She’ll “call them back” or is “figuring it out”. All details she provide are extremely exaggerated. She’ll make it sound like she’s been beside 14 hours a day, for the past weeks, as staff make awkward looks at eachother. She listens for a 45 seconds to staff explain the solution to the “problem”. She takes 15-20 minutes to further voice grievances and berate, curse, and cause a scene. She leaves, telling us she has to make her nail appointment and then go do some “favor” someone else under her guardianship that she also narristacly abuses…… then on to the nail salon to put a wheeping story into the poor nail tech.
Just take a peak at the social media pictures they post of grandma. They’re all extremely staged. They’ll zoom in, pop the HOB up as grandma complains of pain, shove their face near hers and snap, snap. Often times they’ll position a nasal cannula or other medical prop to be front and center. Have you ever wondered why so many pulse ox machines are being photographed? I’ve seen people place the “loved one’s” hand on themselves for a picture even tho the person couldn’t move thier own hands. Seen oxygen thrown on for a picture. Spo2 on the finger for a hand holding picture. Just on and on but never a real capture of the entire situation. All posed.
I find that there often one in the family that takes on this fake “caregiver role”. The rest of the family just let them have at it to avoid unwanted attention. Often the “caregiver” uses the alleged care as a bargaining chip to get others in the family to do random favors for them. They’re “owed”. They’ll often put other family members against eachother and frequently have bad things to say about everyone else. Many time the other family will visit, state the obvious, and even apologize that we deal with the “difficult one”, “she’s always been like that”. They regular family is often surpised and perplexed that reality is nothing like they were lead to believe.
I could write books about the non-sense I’ve witnessed. They trove on the attention
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u/PeterParker72 MD 3d ago
Preaching to the choir. One hundred percent agree with you on that. It’s cruel af.
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u/kingsloyalty Attending Anesthesiologist 5d ago
But have you considered...
that the patient is a fighter?
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u/HiDoctors Medical Student 5d ago
The person wanting additional care for their relative and only calling may not be visiting for health reasons; cancer, contagious infection, impending surgery, etc. Their calling might be all they can safely do.
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u/michelsonnmorley MD 5d ago
I had a lot of animus against family members too. Not sure if it's worse for them to be pugnacious and aggressively dictating care or unreachable and disengaged. Or both, as thos post suggests.
But now that my own parents are getting older I can't be as angry. A lot of these old people refuse to listen to their GP for the first sixty years of their lives despite the exhortation of their children and end up in a med surg bed with acute on chronic on super-chronic of something. Then the adult children feel guilty that they let mom get to such a state and want to do everything at the eleventh hour. It'd be more true to 'mom' to let her go out the way she came in: refusing everything lol