Sandra L. Ragan, PhD

Disclosures

June 13, 2013

A Dying Son, Husband, and Father

Stan is a 42-year-old man admitted to the hospital for end-stage amyotrophic lateral sclerosis (ALS). Stan's disease was diagnosed at age 28 years and has now advanced such that he requires ventilator support at home, where he is cared for by his wife, his 2 teenage sons, and his father.

Stan has been seen on several previous hospital admissions by the palliative care service for the symptoms of this disease. He is now hospitalized with his eighth episode of pneumonia. After extensive deliberation, including consultation with the ethics committee and close support from his rabbi, Stan and his family have opted for palliative care and a do-not-resuscitate (DNR) order.

Over the past 48 hours, Stan has become less responsive and his cardiorespiratory status has worsened. His entire family is present, and he is visited by the palliative care nurse and his primary care nurse in the intensive care unit. All sit in silence until his father speaks to say that they know that this is for the best, and that he is at peace knowing that his son's suffering will soon end. He adds, "This is so much harder to do than I ever imagined." Stan's wife asks the nurses, "Is there nothing we can do for him now?" She further expresses that she feels helpless because she has "no words" to comfort Stan.

Both nurses know that their responses and the care provided by all clinicians in the hours ahead will become lifelong memories of every member of this family. Care of the imminently dying person is an intense orchestration of physical, psychological, social, and spiritual support, all which will be made possible through interdisciplinary teamwork and communication.[1,2,3]

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