How to deal with the families of ICU patients

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How many times have you felt the frustration of patients’ family members who camp out in the waiting room for days on end?

They get someone to bring their meals to the waiting room unless there is a “no food” policy and someone to enforce it. They live and sleep in the same clothes and do not bathe, they compare notes with other family members (so much for privacy and HIPPA rules!) and they bring in expensive treats for the staff. I once had a patient whose son brought in three boxes of Godiva chocolates for each shift (this is part of the “bargaining” stage of coping).

There was a family member who had a cooler with her in the “camping area,” which we later discovered contained a half-gallon bottle of gin. In the middle of the night she got VERY drunk and a “cat fight” ensued with security finally removing the woman. For some reason they brought the bottle of hooch back to me in the unit. As if any of us could drink on duty! (Kind of like the family who brought in the jars of moonshine–but that is another story.)

What you notice after a few days or even weeks is that these family members have begun to exhibit signs of deterioration mentally, physically and spiritually. They are already going through the stages of grief as defined by E. Kubler-Ross, which most of us learned about in school.

In their most vulnerable moments, they’ll begin to nit-pick about small details and practically stalk the doctors. The blame game will ensue among family members, an acute phenomenon in the first few hours or days.

So what do you do to help yourself AND your patient’s family?

I used to tell my patients’ families: “Now is the time for you to take care of yourself and let us do the work. Do something that is part of a regular lifestyle. Sleep at home, go and get your hair done, eat a real dinner at a nice restaurant, etc. Because you will need your strength when Mama gets out of ICU. If something should happen while you are not here, know that there is nothing you could have done if you were here. In an emergency, no one is allowed to come in and we will do everything possible to take care of the problem.”

Be certain you have all of the correct cell and home phone numbers for the family and be sure to call them, as you have promised to do, with any new changes or developments.

Sometimes a patient will pass away when his or her family leaves. When that happens, you will have to explain the unexplainable as best as you can.

Sometimes nothing that you do or say will change a situation like this. In the end, you must respect that the family members have the right to stay or go as long as they are not being disruptive or violating the rights of others.

There is no doubt that it is around the family and the home that all the greatest virtues, the most dominating virtues of human society, are created, strengthened and maintained (Winston Churchill).

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