Why did they take my son’s body away so soon?
Dear Viki,
My son recently died at home with the help of hospice. They were great but I am still really angry that I didn’t know they would take my son’s body away so quickly. When the funeral people showed up, they took him away before I was done saying goodbye. Shouldn’t they know that isn’t right?
I am so sorry that was your experience. And I am sorry for your loss.
Here is what someone should have told you. When you call the funeral home for them to pick up your loved one, they come out within an hour or so. If you had wanted longer with your son, then you should have delayed calling the funeral home. But of course you didn’t know this and nobody explained it to you. Delaying calling them would have given you a little extra time for you to finish saying your goodbyes. You can’t delay calling them for days, but it is okay for a few extra minutes. (If you are anticipating a death in your family, you should ask the mortuary how long it usually takes to pick up someone who has died.) Once they arrive, they should be respectful and compassionate and give you a few more minutes, but they can’t wait for hours once they arrive.
Have a kind and respectful day.
Don’t Tell Grandmother She Has Cancer
Dear Viki,
The other day, I had a family tell me to not tell their grandmother that she had cancer and was going to die soon. I am not sure what to do. I want to be culturally respectful but I also have to make sure that I am doing right by the patient. It is her life, not the families. What should I do?
Great question. If it was 40 years ago, a doctor could keep information from a patient. Now the rules are different. Here is what you need to do to respect the patient and the culture.
1. Speak directly to the grandmother, hopefully without her family in the room. Ask her, “Do you want the results from the tests we are doing or should I be talking to somebody else? Do you want to make your own decisions or would you prefer that someone else make those decisions for you?”
2. If she says, “Yes, I want to know the results and make my own decisions”, then you will know what to do. Tell her the information. You may also want to check with her if she would prefer to have these conversations in private or with her family present. Sometimes it is just as important to the patient to protect their loved ones as well. Respect the patient’s wishes while you show respect for this family’s culture.
If she says, “No, I would rather focus on getting better and let someone else deal with all of the decisions”, you also know what to do. You now must ask her, “Who should I talk to?” Once she tells you who is in charge, and it might be a 2-3 people, then talk to them. This is called a waiver of informed consent. Patients can act autonomously and waive their right to information. You may want to have her to fill out an advance directive or living will ahead of time and check the box on the form that says, “Starting now, I want _____ to make my decisions for me even though I still have capacity.” If she changes her mind later on, then you can follow her new instructions and begin having her give her own informed consent.
Have a kind and respectful day.
Is my grief normal? Do other people cry this much?
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Is my grief normal? Do other people cry this much?
I was sitting with a friend whose husband died 6 weeks ago. She wept and talked then stopped crying and talked then wept again. At one point she asked me, “Is this normal? Do people who you help act like me?” The answer of course is yes. Tears are a normal part of grief. And tears don’t go away quickly. They may last for a lifetime. But the good news is it does get better. When my dad died, the tears wouldn’t stop. Then after a few weeks, the tears only came a few times a day. And now years later, the tears only come up a few times a month.
You shouldn’t have to apologize or excuse yourself for real emotion. If you didn’t love the person, then you wouldn’t cry. And if you aren’t crying, that is okay too. Everyone uses different emotions to process their grief. You may be angry or tired or numb. The only thing you need to do is to experience the grief and overtime it will get easier. If it isn’t getting easier, then get some help.
Have a kind and respectful day.
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When I go to the Emergency Room, why is the wait so long?
Dear Viki,
When I go to the Emergency Room, why is the wait so long?
Basically there are only so many beds in a hospital and an emergency room. If there is overcrowding in the hospital, the emergency room will get overcrowded with people waiting to be admitted to the hospital. I know someone that spent three days in the emergency room because there were no beds available in the rest of the hospital. She got her meals, her physical therapy, her medical tests, her x-rays, etc done while she lay in the hallway of the ER. Eventually she got better and was discharged home. She never made it to a regular hospital room.
So how long you will wait to be seen in the emergency department will depend on many factors. Here are just a few:
- How many people got there before you
- How sick you are
- How sick the other people are
- How crowded the whole hospital is
- How many ambulances are arriving outside
- How many other ER’s are available in your area
- People go to the ER when they have a cold or aren’t really sick and take up the doctor’s time
- People go to the ER because they don’t have insurance and the ER has to treat you even if you can’t pay
- People go to the ER because they didn’t want to take time off from work to go to their doctor’s office
- People go to the ER because they kept waiting and hoping they would get better and by the weekend, they still aren’t better
If the other patients already there and those in the arriving ambulances have a more life threatening condition, your wait will be really long. Sorry. Basically the nurses will do something called triage. They have to evaluate who needs help right away and who can wait. I live in an area where many of our emergency rooms have closed because there wasn’t enough money in Los Angeles to keep them open. It puts tremendous pressure on the hospitals that still take care of emergency patients and increases our wait time.
What can we do?
1. Don’t take it out your anger and frustration on the nurses and doctors in the emergency department. They know you had to wait and they wish it was different too. When they go to the ER themselves, they have to wait. They understand and are doing the best they can.
2. If you aren’t really, really sick, go to your doctor’s office. Or go to the urgent care.
3. If you are sick on a Friday morning, go to your doctor’s office. Don’t wait until 6 PM and then go to the ER.
4. Go prepared. Bring all of the medicines and other pills that you have been taking with you in a bag. You shouldn’t be surprised to have to wait. Bring something to read or do with you.
5. Ask your state to provide more resources for the local hospitals.
Have a kind and respectful day.
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My mom just died. What do I do with her medicines?
Dear Viki,
My mom just died. What do I do with her leftover medicines?
I am sorry for your loss. This is a great question because the answer has recently changed. In the past, most people flushed their old medicines down the toilet. This was done to prevent accidental poisonings of children and animals who may find medicines in the trash. But today, the Environmental Protection Agency (EPA) no longer recommends this. Sewage treatment plants may not be able to clean all medicines out of the water. This may harm fish, wildlife or us.
Besides taking care of your mom’s medications, you may want to check to see if any of your own medicines should be discarded because they are too old or aren’t needed anymore. The bottle or container will have an expiration date on it. If the medicine doesn’t have an expiration date, unless you know you purchased it within the past year, you should dispose of it as I explain below. Medicines may lose their effectiveness over time, especially if they are in a warm, moist, bathroom medicine cabinet. In rare cases, taking expired medicines can become dangerous and life threatening.
To dispose of drugs according to the American Pharmacists Association:
1. Read the instructions on the medication for specific information regarding disposal.
2. Remove and destroy ALL identifying personal information (prescription label) from the medication container.
3. Take capsules and tablets and make them unusable by wetting, breaking or crushing them; then place them in a childproof container, sealed with tape and toss in the trash.
4. Mix prescription drugs with an undesirable substance such as used coffee grounds or kitty litter and put them in non-descript containers such as empty cans or sealable bags.
4. Empty liquids onto absorbent paper towels or rags and dispose with regular trash.
5. You can also check for approved state and local collection programs or with area hazardous waste facilities.
6. In certain places, you may be able to take your unused medications to your community pharmacy. Ask your local pharmacist what he recommends.
Should a doctor treat their own family members?
Dear Viki,
What is your take on doctors who take care of patients with whom they have a personal relationship including families and how should hospitals deal with this?
Thanks for asking this question. This is an ethical problem that is regularly ignored and has always bothered me. The quick answer is that doctors shouldn’t treat loved ones unless it is an emergency and no other doctor is available or if the patient is in an isolated place and no other doctor is nearby. This would never be the case in a hospital setting where another doctor is readily available. Hospitals should have a policy against this behavior. This may be more difficult to deal with in rural communities but every effort should be taken to protect the patient.
I have heard doctors tell me that they can be objective. They may think that they are able to be objective, and maybe one or two can, but they can’t change what the patient is experiencing. Patients may not be willing to tell the whole truth to their family member, may be embarrassed to be examined by the family member and may feel pressured to do what the doctor/family member says even though they disagree with the plan. And it doesn’t have to be only with family members. It can also be a problem with friends who are healthcare providers. Doctors should hold themselves to the higher standard and live by their own professional code of ethics.
Here is what the American Medical Association has to say about it in the physician’s Code of Medical Ethics:
E-8.19 Self-Treatment or Treatment of Immediate Family Members
Physicians generally should not treat themselves or members of their immediate families. Professional objectivity may be compromised when an immediate family member or the physician is the patient; the physician’s personal feelings may unduly influence his or her professional medical judgment, thereby interfering with the care being delivered. Physicians may fail to probe sensitive areas when taking the medical history or may fail to perform intimate parts of the physical examination. Similarly, patients may feel uncomfortable disclosing sensitive information or undergoing an intimate examination when the physician is an immediate family member. This discomfort is particularly the case when the patient is a minor child, and sensitive or intimate care should especially be avoided for such patients. When treating themselves or immediate family members, physicians may be inclined to treat problems that are beyond their expertise or training. If tensions develop in a physician’s professional relationship with a family member, perhaps as a result of a negative medical outcome, such difficulties may be carried over into the family member’s personal relationship with the physician.
Concerns regarding patient autonomy and informed consent are also relevant when physicians attempt to treat members of their immediate family. Family members may be reluctant to state their preference for another physician or decline a recommendation for fear of offending the physician. In particular, minor children will generally not feel free to refuse care from their parents. Likewise, physicians may feel obligated to provide care to immediate family members even if they feel uncomfortable providing care.
It would not always be inappropriate to undertake self-treatment or treatment of immediate family members. In emergency settings or isolated settings where there is no other qualified physician available, physicians should not hesitate to treat themselves or family members until another physician becomes available. In addition, while physicians should not serve as a primary or regular care provider for immediate family members, there are situations in which routine care is acceptable for short-term, minor problems.
Except in emergencies, it is not appropriate for physicians to write prescriptions for controlled substances for themselves or immediate family members. (I, II, IV) Issued June 1993.
Why did the doctor do CPR against the patient’s will?
Dear Viki,
I just got the call that my father-in-law was resuscitated (got CPR) twice even though he had a DO NOT resuscitate order in place. Instead of a being allowed to die, now he is in the ICU and receiving care he doesn’t want. What just happened? What do I do next?
Even though this isn’t supposed to ever happen, it happens at all hospitals. A DNR or a do not resuscitate order should be followed but sometimes because people are in a hurry or don’t check the chart or don’t agree with the order, and the person is brought back to life against their will. This is a terrible thing for the patient and family to go through, Instead of the patient getting to die a natural death, they receive medical care against their will.
Here is the truth about this situation. If the medical professionals knew that there was a DNR in place, then what they did to your father-in-law is called assault and battery. The people involved can be arrested and criminally charged. And I need to let any healthcare professionals that might be reading know that your malpractice insurance won’t cover this because it is a criminal offense.
But what can you do now that it has happened. The best thing to do is to talk to the nurse and find out if they realize they made a mistake. (Don’t be hostile or aggressive as these caregivers are still taking care of your father-in-law.) Be polite and make sure that there really is a DNR written on the chart and that they will make sure it is respected. Sometimes we think these instructions have been written but the doctor hasn’t gotten around to it or won’t write it. There are some physicians that are morally opposed to the DNR and are supposed to tell you that they won’t do it. But many times they won’t tell you or even let you know it is a valid medical option. If the doctor won’t write the DNR, then fire that doctor and get another doctor to write it immediately.
You may also want to notify the hospital administrator who is on call. Let them know what has happened and they can help you. The other person that can help you is the social worker. The social worker will know who to call and will help advocate for the patient.
Another note: I spoke with this person directly and found out that the family thought that the patient had a DNR but really only had an advance directive that said do not resuscitate. Those wishes were not transferred onto the chart. This is something we need to be careful about. Just because the patient may have refused a certain treatment, it doesn’t really count until it is known by someone on the healthcare team. Of course the patient’s wishes should always be respected, but these are serious orders about life and death and they must be written out by the doctor. (It still might be assault and battery if the patient’s wishes in the advance directive were known by the healthcare professionals.) Make sure you go over your loved one’s advance directive doctor when you arrive at the hospital.
I Am in Pain, What Can I Do?
One of my hospice patients just called and said that his pain is at a 7 and he doesn’t know what to do. He saw his doctor and the doctor didn’t take care of his pain and said, “See you in two days.”
Are you kidding me? I would like to see this doctor stay at a pain level of 7 for 48 hours. The doctor wouldn’t put up with this if he was suffering and would make sure his own doctor took care of him. But he ignored my patient. When I hear about his happening, it makes me so angry.
Now I know, you must be thinking, “How can this be?” Well this happens a lot for many reasons. Let me tell you a few so you can know how to fix it.
1. The patient doesn’t speak up enough about the pain. If you don’t tell the doctor, how can he help you? If this is you or your loved one, do not leave the office until there is a new plan in place. And the plan should include a time limit for it to start working. If the new pain medicine hasn’t gotten your pain under control within a few doses, then you should call and tell the doctor and then he should adjust the plan.
2. The doctor doesn’t know how to take care of pain symptoms. Okay, now you are really surprised to think of a doctor that doesn’t know how to take care of pain. Well again, this happens all of the time. Most doctors can handle basic pain management but many are uncomfortable when they have to deal with the increasing pain that happens with cancer or other progressive diseases.
3. Maybe you are from a culture where you are encouraged to be brave and stoic about your pain. Now the doctor will end up misunderstanding about your pain and you won’t get the care you need. The doctor will ask you, “How is your pain on a scale of 1-10” or he will use the happy face chart. This works fine if you tell the truth about how much you are hurting but not if you don’t. So speak up and admit you are in pain.
4. Finally, and this will sound harsh but there are some doctors that don’t seem to care. If so, immediately get a new doctor. You should not go through your life in terrible pain and especially if you are dying. You should not have your final days be in pain. If you are dying and your pain is not being taken care of, then ask your doctor to put you on hospice. Hospice doctors and nurses are really good at taking care of pain and suffering.
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