Impatience

The cognition was fading, more rapidly than anticipated.  An intervention that would likely prevent it was not what the patient wanted after watching a loved one die of the same.  The primary team called an emergency family meeting to get a decision made.  The patient refused to let anyone make decisions except them and yet, they could not follow the conversation.  The family was afraid to make decisions because of past history of animosity and anger if things didn't go the way the patient wanted.  The onus was put on us to get a decision made.

It's amazing how easy it is to feed into that sense of impatience.  I felt like I didn't get to do things the way I prefer to - get to know the patient, figure out what's important to them, determine what treatments they for sure knew they did or did not want before being thrust into forcing the patient's hand on a decision.  Instead, the rapidly fading mental capacity of the patient led to a hard push to try to get a decision made, and it ended in the patient's family getting the silent treatment.  That, I felt, was my fault for not doing things the way I typically do them.

Today, we got nothing from the patient.  The chemicals in the blood already having their affect on the clarity of consciousness.  The edge that was present yesterday, was gone today.  The patient is rapidly becoming a shell of themself.  The family is still paralyzed by the patient's previous indecision.  The team was impatient, angry that we hadn't "made the patient hospice" so they could get rid of them.  It was heartbreaking.

How do you balance doing what feels right for you when it comes to setting up the conversations at hand with the expectations of the primary team and the abilities of the patient?  Knowing that this patient wanted to make all of their own decisions without family intervention makes it harder now because that's not possible.  We have no information on what the patient wants us to do beyond the things they don't want.  How do we proceed.  We know the patient does not necessarily need to be in the hospital, and yet the family is saying they wouldn't want multiple other options that would be supportive of the family.  Where do we go from here?  How do we support the family into inertia to make a decision?  How do we block them from the pressure of the impatience of the primary team?  How do I keep myself from also giving into the pressure of external impatience in the future?