"We are going to go together"

[Sasha]

I recently took a hospice patient home. He was in bad shape, breathing was sporadic, about 8 a minute. Valid DNR, per doctor he was allowed to have 2 LPM via NC.

Wife came along, we let her ride in the back due to the fact we were uncertain just how long he would have lasted on a half hour transport time. Wife is quite hysterical about the whole thing, and states "We're going to go together"

Wife is young, in good health, but insists she's going to go to heaven soon after her husband.

Would you have taken this as a vocalization of suicidal ideations? Why or why not? What would you have done?

 

[JPINFV]

Does she have a plan?

 

[Aidey]

I would have. It may be part of the grief she is experiencing, but I think it should be taken seriously. Even if she isn't serious, she could probably benefit from some grief counseling.

In my area there is the official state Hospice program, and then other independent programs through individual facilities and such. If the patient was a Hospice patient I would probably call the on call Hospice RN, or the charge RN at the main Hospice facility and speak with them.

 

[medichopeful]

Most definitely. I would do what you can to get her help, or at the very least evaluated.

 

[LondonMedic]

Would you have taken this as a vocalization of suicidal ideations? Why or why not? What would you have done?

I would suggest that it depends very much on the rest of your mental state examination.

Personally, if I were EMS, I'd have just made sure that one of the senior nurses at the receiving unit was aware of this woman and her threat and left it at that - unless you want to diagnose this lady and start stratifying her risk*.


*And that's another set of paperwork!

 

[BLSBoy]

I had a response, but I forgot it after reading the TOS. :wacko:

 

[triemal04]

I recently took a hospice patient home. He was in bad shape, breathing was sporadic, about 8 a minute. Valid DNR, per doctor he was allowed to have 2 LPM via NC.

Wife came along, we let her ride in the back due to the fact we were uncertain just how long he would have lasted on a half hour transport time. Wife is quite hysterical about the whole thing, and states "We're going to go together"

Wife is young, in good health, but insists she's going to go to heaven soon after her husband.

Would you have taken this as a vocalization of suicidal ideations? Why or why not? What would you have done?

Is she saying that she is going to kill herself? No. Would it be a good idea for her to get some type of grief counseling? Yes.

People tend to react in varied ways when confronted with that type of situation and the above is one that's not entirely uncommon; it's part of the stages of grief. This doesn't necessarily mean that the lady is at risk of killing herself, just that she is in a very emotional state and needs help. Basically, treat her like you would any other family member that just had a loved one die; find out what you can do for her, if there is anyone you can call, if there is something you can do to make things easier for her. And once you drop of the husband pass on the fact that she is not taking this well to the staff (if you're at a nursing home) or any family that is at his private residence.

Denial...anger...bargaining...depression...acceptance...where do you think she was right then?

 

[JPINFV]

People tend to react in varied ways when confronted with that type of situation and the above is one that's not entirely uncommon; it's part of the stages of grief. This doesn't necessarily mean that the lady is at risk of killing herself, just that she is in a very emotional state and needs help.

I definitely agree with this. The one concern I have over scenarios like this is that people reading the thread won't draw the line between referring to counseling resources and attempting to obtain a psych hold. Not every utterance of something along the lines of 'my life feels worthless now' should result in someone being dragged from their home in the middle of the night to a psych hospital for evaluation and treatment (and yes, I've been on those transports taking patients who are on holds for just that reason from the local ER to the local psych unit).

 

[triemal04]

I definitely agree with this. The one concern I have over scenarios like this is that people reading the thread won't draw the line between referring to counseling resources and attempting to obtain a psych hold. Not every utterance of something along the lines of 'my life feels worthless now' should result in someone being dragged from their home in the middle of the night to a psych hospital for evaluation and treatment (and yes, I've been on those transports taking patients who are on holds for just that reason from the local ER to the local psych unit).

That's a justifiable concern unfortunately. But...guess what would help fix that? That's right...education! Part of my degree was a class called "crisis intervention and management," which, combined with a basic psych and sociology class would do wonders for anyone facing that type of situation. Having even a basic understanding of where someone is coming from when they say that type of thing in that type of situation would help to determine what to do.

 

[CAOX3]

What can you do, support, make the family aware of her thoughts, as stated above these are very sad situations, losing the person you ve spent the majority of your life with can stir feelings of not wanting to continue on yourself, no matter the age.

Hopefully she has a strong support structure and finds reason within herself to continue on.

 

[mycrofft]

Given the original poster's info only...

(and having worked on a telephone crisis intervention hotline thirytmumble years ago), that lady needs to not be left alone and could benefit from professional help. Suicidality is impossible to tell from the information given, but trust your "spider sense" on these.

An observation: hysterical, manic or raging people may try to harm themselves paroxysmally (grabbing an object at hand, trying to jump from a vehicle, breaking a restroom mirror or drinking cleaning materials they run across); lethality varies from very low to very high depending upon their environment. They may also harm others.

Quiet considerate and even upbeat people can have a consistently higher lethality because they have a plan, they are organized, and they are no longer ambivalent.

 

[firetender]

What if, after delivery of your patient, YOU took the time to sit and talk with the woman? Not to "assess" her, but to be an open ear for a human being in a distressed state. Then, you'll know what she means, and you might even learn something.

 

[Aidey]

What can you do, support, make the family aware of her thoughts, as stated above these are very sad situations, losing the person you ve spent the majority of your life with can stir feelings of not wanting to continue on yourself, no matter the age.

Hopefully she has a strong support structure and finds reason within herself to continue on.

I'm not sure I would feel comfortable talking to the family about it. I would have no idea what the family dynamic is or any issues/politics between people. Sasha's patient was being transferred home, and there may not be anyone else there besides the patient and wife. I would also be concerned that talking to the family myself would be see as over stepping my bounds by the family, the Hospice staff and by my employer if any of the first two groups complained.

The Hospice RNs and other staff are used to addressing these issues in the family, and I think they would be the best equipped to approach the wife and the family if needed. I know that the Hospice staff approach the situation as if the whole family are their patients, and they offer official counseling and an ear for "I just need to vent" situations. The wife may have already talked to staff at the Hospice house, and they may be aware there is an issue.

 

[Aidey]

What if, after delivery of your patient, YOU took the time to sit and talk with the woman? Not to "assess" her, but to be an open ear for a human being in a distressed state. Then, you'll know what she means, and you might even learn something.

While I don't disagree with this, it makes me wonder if it would establish a legal provider-patient relationship, requiring a PCR and all that.

 

[reaper]

Do you write a PCR for ever person you talk to? If you are just talking with the wife and not providing vare to her, then you are there as a fellow man! (or woman)

 

[Aidey]

Well, that is my question. At what point does it legally switch from "just a chat" to you acting as a medical provider, especially if you then end up relaying your concerns to someone.

 

[Sasha]

What if, after delivery of your patient, YOU took the time to sit and talk with the woman? Not to "assess" her, but to be an open ear for a human being in a distressed state. Then, you'll know what she means, and you might even learn something.

What do you think I did during the half hour transport? With a DNR there was really no care I could give the patient, so aside from checking to make sure he was still breathing I had nothing else to do than to talk to her, and suprisingly she talked about many subjects, not just him. Sticking around after transport is really out of the question, for most transports we are given 30 minutes at the drop off until we are expected to be back in service. This may seem like a LOT of time, but on a home hospice call where we have to move furniture, and make sure the family can operate the equipment the patient is on, it's really a short time.

Aside from that I've got absolutely no education or training in crisis management or counseling etc. am not qualified to do anything more than to listen and offer her a 4x4 when she cries (in the absence of tissues.)

What I DID do with the patient and family member was actually a lucky break. Right as we were putting him in bed, the hospice nurse pulled up. So I pulled her aside to "give report" and told her what was going on. She is more able to get the woman in contact with the resources she needs and also to talk to her about what is going on than I am. The company doing the patient's hospice has a GREAT grief counseling and crisis management program and great staff, so I'm confident the patient's wife was in good hands.

 

[Jon]

I think it would.... and if you are gonna be reporting her, it most certainly does.

 

[rescue99]

What do you think I did during the half hour transport? With a DNR there was really no care I could give the patient, so aside from checking to make sure he was still breathing I had nothing else to do than to talk to her, and suprisingly she talked about many subjects, not just him. Sticking around after transport is really out of the question, for most transports we are given 30 minutes at the drop off until we are expected to be back in service. This may seem like a LOT of time, but on a home hospice call where we have to move furniture, and make sure the family can operate the equipment the patient is on, it's really a short time.

Aside from that I've got absolutely no education or training in crisis management or counseling etc. am not qualified to do anything more than to listen and offer her a 4x4 when she cries (in the absence of tissues.)

What I DID do with the patient and family member was actually a lucky break. Right as we were putting him in bed, the hospice nurse pulled up. So I pulled her aside to "give report" and told her what was going on. She is more able to get the woman in contact with the resources she needs and also to talk to her about what is going on than I am. The company doing the patient's hospice has a GREAT grief counseling and crisis management program and great staff, so I'm confident the patient's wife was in good hands.

Sasha,

You handled it exactly right. You let the nurse know the demeanor of the spouse and let her take it from there. No need to write a PCR when you never had patient contact with the spouse.

 

[CAOX3]

I'm not sure I would feel comfortable talking to the family about it. I would have no idea what the family dynamic is or any issues/politics between people. Sasha's patient was being transferred home, and there may not be anyone else there besides the patient and wife. I would also be concerned that talking to the family myself would be see as over stepping my bounds by the family, the Hospice staff and by my employer if any of the first two groups complained.

The Hospice RNs and other staff are used to addressing these issues in the family, and I think they would be the best equipped to approach the wife and the family if needed. I know that the Hospice staff approach the situation as if the whole family are their patients, and they offer official counseling and an ear for "I just need to vent" situations. The wife may have already talked to staff at the Hospice house, and they may be aware there is an issue.

EMS is never black and white, sometimes you have to overstep your bounds whether it be pt advocacy or informing somone of the information you have received, such as the wife in this situation. Simply letting it slide could mean the difference between this woman continuing on in a productive manner or losing the will to live. Im willing to risk and I have, the complaint if it opens someones eyes to the problem their family member may be facing.

I also believe Sasha handled this difficult situation the right way.