CAN'T AGREE

“Ingrid”, seventy-two, took a fall six days ago. She says she lost consciousness and fell flat on her face. The left side of her face is bruised from that fall. Ingrid has a history of lung, cardiac and kidney disease. Ingrid lives with “Edgar”, her husband of fifty-five years. The couple have five adult children; although only two live locally.

Due to Ingrid’s recent decline, the hospice nurse and I went out to admit Ingrid to hospice. Ingrid’s husband and two of her children, “Jim” and “Liz“, were at the bedside when we walked into her hospital room. The plan was to discharge Ingrid home today.

After we introduced ourselves, Edgar, Jim and Liz immediately started talking all at once, overpowering Ingrid. The three of them would interrupt each other and order each other around as to what to say or do.

One of the first questions I like to ask patients and families is about their understanding of why the doctor made a hospice referral. The doctor may have predicted a life span of six months or less, but often one can be selective to what they are ready to hear. There are times, when the doctor doesn’t even share why it is time for hospice to be involved. I don’t want to assume the family understands why.

I had directed that question to Ingrid. She was attempting to answer my question, but was struggling with the words. The family started to talk for her. Each one had a different answer as to why a referral was made. Finally Liz told her brother and father that I had asked Ingrid about what her thoughts were. Ingrid has been on oxygen since in the hospital, but hadn’t been prior. With her extensive lung disease, her fuzziness may be from lack of oxygen to her brain. The family did not have the patience to allow Ingrid to articulate in her own way.

Between the three of them, there was a lot of anxiety and impatience to get things done right now. One could feel the tension in the room, but also feel the love all three had for Ingrid. This frenzied behavior is normal for this family and somehow works for them. The one thing any of us miss most is our normal. Normal is what Ingrid needs. I just bet she can’t wait to get home to her “lively” normal.


CAN’T AGREE

　
The three of them were so vigilant.
Their concern directed only for her.
She’s been in the hospital for almost a week.
They just want to get her home.

The plan is to discharge her later today;
once the oxygen and bed get set up at home.
She’s been a bit fuzzy; not quite herself;
since she took that dramatic fall.

All three believe they know what’s best.
None of them think to simply ask her.
They interrupt each other constantly;
each determined in what she needs.

He gets anxious; his son says to calm down.
She starts to say something, but stops midway.
The three of them jump in all at once,
finishing up what she must mean.

They can’t agree on anything.
They all have their own ideas.
What she needs; what is best.
All three set in their own ways.

Between the bickering and the interruptions;
there is at least one thing
they can easily agree;
their love and devotion
       to her.