Abstract
It was a busy night shift for Trunesh, a nurse with initial education in Africa working on an intensive care step-down unit. One of her patients was Mrs. Smith, an older African American woman whose husband would plead to stay with her even after visiting hours had ended. He seemed to remain by her side all day! Mrs. Smith had advanced-stage lung cancer and respiratory failure, and her relatives had been told that curative options had been exhausted. Her advance directives included Do Not Resuscitate (DNR). However, Mrs. Smith had five adult children from a previous marriage. The oldest of her daughters, Mrs. Lamar, was her health care proxy and power of attorney, a pleasant woman who seemed to have everything under control. At around 5 a.m. she had called the unit to ask about her mother's condition, and to see if she could talk to Nurse Trunesh after her shift that morning. Nurse Trunesh wondered what the meeting would be about, but agreed to meet her at the lobby after her shift at 8:30 a.m. Mrs. Lamar was waiting for Trunesh in the lobby when she got there. “Hi!” Trunesh greeted her visitor cheerfully. “How are you doing?” Mrs. Lamar replied. “Okay. What can I do for you?” Trunesh asked. “Can we go to the cafeteria and talk over a cup of coffee?” “Sure.”
After each had ordered something, Nurse Trunesh repeated her question: “What can I do for you?”
Mrs. Lamar related how she had a family meeting with her siblings and stepdad on where to bury her mother after her anticipated demise. How her stepdad had told them that their mother had opted for cremation. Three of her younger siblings had concurred, but she – the oldest – did not believe her mother wanted to be cremated. She told Trunesh she felt she had let her mother down and would really feel relieved if only she knew she was doing the right thing; she needed help to figure that out. Trunesh listened attentively through it all, and then replied, “But I am not in the ethics committee, neither am I from around here… I have a different set of beliefs and culture and…” Mrs. Lamar said, “I know… but you are so easy to talk to, Trunesh… I'm sorry to put you on the spot, I only need help to figure out what to do.” “Okay,” Trunesh said thoughtfully, “I'm going to ask you some questions and maybe then you will be able to make a decision you are comfortable with for your mother.”
“First, does your mother have parents?” “No,” Mrs. Lamar said, “They have been dead for over eight years; grandpa died first and grandma followed three years later.” “What did your mother do each time?” “Well, my mother bought a piece of land in a cemetery and buried her father there. She buried her mother in the same place.”
“Does she have any siblings?” Trunesh asked. “Yes, she used to have a brother. He passed away in a nursing home and my mother buried him at the same cemetery. She also buried the son she had with my stepdad there when he died in a car crash two years ago.” “Well,” Trunesh said, “What do you think your mother would want, based on these things you've told me?” Mrs. Lamar kept quiet and was in deep thought for some minutes and then said, “Oh! Thank you, thank you, Nurse Trunesh! I know exactly what she would want – to be buried with the people she loved! Not cremation!” “How so?” Trunesh asked. “Well, for once that was not written down. I'm not saying she and my stepdad did not talk about it, but I think my mother would have written it down! Thanks again Trunesh…You will make a very good psychologist, you know!” “Thanks,” Trunesh replied, “but a good nurse is all I wanted to be.”
“You sure are, you sure are and thanks!”
When advance directives are not clear or relatives are confused about patients' wishes, it is appropriate to review a patient's life history for relevant “advance actions;” relatives or health care proxies should be encouraged to do just that.
Note: No actual names have been used in this narrative.