The Family Member From Hell?

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DutchgirlRN

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I have a friend who is also an RN, she has never worked in a hospital and doesn't know anything about floor nursing. Her husband had an emergent colon resection and in the process the doctor saw that he had mets in the liver and then through a CT scan found that he had lung cancer. He's been in the hospital for 19 days now and she is freaking out because he's on TPN (says he's wasting away without food, that they are starving him) he developed an ileus, freaking about his WBC (obviously low because he's on chemo) thinks he has leukemia too and just not telling her, freaking because she read in his chart that his prostate is enlarged yet RT is giving him IPPB treatments when she read on the net it should be contraindicated.

She says she's yelling at the doctors and nurses and telling them "I'm an RN and I know what you should be doing and you should do what I tell you". They have offered to transfer him (I'd bet they'd do it in a NY minute!)

How do I kindly tell her she needs to shut the heck up? I told her when my Dad had a CABG I didn't even tell the surgeon or any of the nurses that I was an RN. What would the reason be? I expect they'd treat my Dad the same way whether they knew or not so I kept my mouth shut.

Opinions?

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No single healthcare provider knows everything when it comes to such a complicated patient. Physicians will almost always defer to other specialists when a concern is outside of their scope of practice. With that being said, I am an MD who will be constantly relying on these specialists for their guidance and expertise. As it is impossible for an MD to understand every aspect of medicine, so is it impossible for an RN to do the same.

In all seriousness, your friend should probably speak with someone regarding how she is feeling and coping with the situation; I would probably recommend this to anyone in a similar situation, regardless of whether or not they are acting out like your friend. This doesn't necessarily need to be a professional therapist, possibly a clergy-person if she is religious or a support group for spouses of cancer patients.

As I am sure you are aware, your friends behavior is a classic maladaptive coping mechanism. She was presented with a situation in which all of her control as been removed, her acting out towards the medical staff is her way of trying to regain the control she has lost. You differ from your friend in that you probably have development positive coping mechanisms which allowed you to handle your father's illness in a more productive manner.

Telling her to "shut the heck up", probably won't accomplish too much. Her response to the present situation is aggression and that phrasing will only provoke more aggression. If you feel so inclined to get involved, you are best to stay on her side, but introduce the notion that there are possible alternatives to her conclusions. You could remind her that all healthcare professionals lose their objectivity when friends and family are ill, that it is important to have the input of objective (non-personally involved) professionals (that is why most doctors do not care for family members when the health concern is anything but trivial). You can also remind her that she is entitled to a second opinion and even possibly a third opinion, but if there are two or three physicians that agree with the diagnosis, prognosis, and treatment, then she may need to accept their course of action. You can remind her that "yelling" at the doctors and nurses won't accomplish anything (as a nurses, how receptive would the two of you be to yelling family members); if she has a valid concern, but is yelling about it towards the medical staff, they are probably less likely to be receptive. The alternative is that she calmly presents her concerns to the physicians / nurses and asks for explanations why her concerns are unfounded. To facilitate this, she could make a list of all of her concerns, give a copy to the medical / nursing staff and tell them that she wants to have a discussion regarding these issues. That way everyone involved knows what is going to be discussed and when any concerns will be address (A family and healthcare team meeting would not be unusual for such a complicated patient situation).

I hope some of this helps. I wish your friend and husband luck.
 
Well said.

It's quite common for otherwise intelligent, educated people (with backgrounds in medicine, no less) to react this way to this situation. As a nurse, I'm surprised you don't recognize this.
 
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Tremulous Needle thank you so much for your kind and very appropriate reply. I am saddened to say that my friends husband passed away on Friday June 11th.

She, my friend was still being totally inappropriate. I realize she is grieving and is in a state of denial but I felt I did need to gently give her a dose of reality. Her husband had SCLC with mets and apparently quite extensive by the time it was found. Thursday night his spleen ruptured. They refused to do surgery on him and put him on comfort measures only. She was ready to call a lawyer and sue everyone involved. She kept saying that her husband would still be alive had they done a splenectomy. She was saying he would have been able to beat the cancer with her help. I basically told her the truth. The prognosis with SCLC, where the blame lies (the cigarettes) and that it would make no sense what-so-ever to do surgery on a terminally ill man and that with the DIC he would not have survived the surgery. Be thankful they had an opportunity to say goodbye and that he was saved a slow painful death due to the cancer.

She took it well and she has given up on trying to sue everyone. I felt like she wouldn't be able to move on at all until she got it out of her head that he was perfectly healthy until the minute that he checked into the ER. He obviously already had extensive mets.

Thank you again for your reply.
 
My condolences and you're welcome.

I reiterate my previous recommendations that she find someone to talk to, it sounds as though she may need assistance developing positive coping mechanisms that will get her through her tragedy.

Good luck.
 
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