Lessons from the Silence

Abstract

I t was a busy day in the Palliative and Comfort Care Unit (PCCU), so I felt a bit pressured as the consult team called in the information on the next patient to be transferred. Mrs. Stubblefield* was a 69-year-old woman with metastatic cancer, admitted a week prior with dyspnea due to ascites and bilateral pleural effusions. Despite aggressive attempts at draining the fluid collections, her respiratory symptoms had progressed and eventually it was felt that ventilator support would be needed to extend her life. At that point the patient made it clear that she did not want to be on a ventilator. She realized there was no cure for her disease and a ventilator would only prolong her suffering. Because she was still awake, she was placed on a BiPAP machine, but eventually became unresponsive on it, and so the time had come to remove her BiPAP.The palliative care consult team had met with her grandson and his wife the night before, and they were in agreement with transfer to the PCCU, subsequently removing the BiPAP, and focusing on comfort measures. Brandon,* her grandson worked during the day and would be here after she was transferred to discuss when the BiPAP should be removed. The patient had a daughter, Brandon's mother, who lived in another state and would not be here to bid farewell to her mother. That caused me to briefly reflect on what type of relationship the two had experienced, but I was glad that Mrs. Stubblefield had a grandson who was active in her care and was making decisions on her behalf. The consult team had mentioned that Mrs. Stubblefield had raised Brandon since he was three years old, so he should have a clear understanding of what her wishes would be under various medical circumstances. In my mind, I pictured Brandon to be a man in his mid-to late twenties. He would be understandably saddened by his grandmother's impending death, yet polite and quick in his decisions. After all, there was really nothing else to do for her other than to focus on comfort, and he seemed to have understood that already. I was glad his wife would be there to lend support, but felt that our meeting in the afternoon would be rather routine and predictable, and we would then move on with our work and lives.Upon being notified by the floater nurse that Brandon had arrived, I immediately proceeded to Mrs. Stubblefield's room, anxious to do what I needed to before accepting another transfer. As I entered the room, I was surprised by the fact that Brandon had already moved a chair to his grandmother's bedside, and was holding her hand; generally the forethought to do this is reserved for older and wiser family members. His wife and in-laws were sitting on sofas removed from the bedside. They offered me a place to sit beside his wife, separating her and her family from Brandon and Mrs. Stubblefield. Initially I thought this was awkward, generally preferring to counsel family members grouped together, so they could offer emotional support to one another. However, I sensed that Brandon preferred the arrangement, signifyin...

A socio-cultural investigation of Indigenous Fijian women’s perception of and responses to HIV and AIDS from the two selected tribes in rural Fiji: Tabalesi na Dakua, Ukuwale na Salato

“…Informants discussed the need to provide individuals and families opportunities for counselling and other support services, psychological distress (bereavement coping stress, traumatic stress), grief reaction, social support, coping skills, substance use, and an intervention to improve quality of life. There should be a model of grief counseling and support to be developed in Fiji (Bearden, 2011;Sikkema, 2005) to target psychological distress.The key components of this intervention model include: 1) development of social support and group cohesion; 2) identification and expression of emotions related to HIV and loss; 3) identification of coping difficulties specific to living with HIV infection and AIDS bereavement; 4) identification of current coping strategies.Measures such as these are important to increase acceptability of HIV services to these communities.…”