Navigating conflicting crisis styles in a family

October 5, 2022 2:25 PM

On my way to relieve my sister who has been at the hospital with our mother since yesterday morning. Sister wants to sit right there in the room constantly, gets pissy with staff for not doing their jobs to her standards. I'm more the sort to think it's ok to walk down the hall to get a coke. My sister will be livid if she finds out I approached it like that when it's my turn for the overnight. Help me avoid drama.

Do I just create a white like here or what? I can't just sit in a hospital room 100% of the time for an overnight stay. I will go crazy. And, I might know BLS but if my mother codes she has a DNR. My sister's style is to rescue and be super intense. I can't do it like that. It's taken years to even be able to be in a hospital for an extended period of time.

If my mother appeared to be cognitively herself this would be a different conversation but she may have had a stroke or severe seizure and doesn't even know my sister's name. Sitting in the room without walking around at all in these circumstances is not something I can do, and do not believe that it is necessary or I'd find some way to do it anyway.

But. I don't want drama with my sister. So how do I do some hand waving to ensure she won't know if I took a pacing break at 3am or whatever?

posted by crunchy potato to Human Relations (23 answers total)

So how do I do some hand waving to ensure she won't know if I took a pacing break at 3am or whatever?

She's not there. How would she know?

It's one thing to remain at a bedside constantly the day a family member is rushed to the hospital. But when people have been in the hospital for a while, even when they're near death, people will go smoke a cigarette or equivalent. It's simply not possible to remain there constantly for days on end without taking short breaks!
posted by praemunire at 2:31 PM on October 5, 2022 [28 favorites]

How would she know? Has she got a camera in there? Why would you tell her? Who else would tell her? Just go, say good bye when she leaves and do you.
posted by koahiatamadl at 2:33 PM on October 5, 2022 [4 favorites]

Don't tell her? The nurses are busy and your mother is very ill--no one is going to "tattle" on you.
posted by kingdead at 2:33 PM on October 5, 2022 [5 favorites]

Best answer: How would she know?
Do you expect her to check in with you at random times?

If you think she might call or text you to catch you out, and you don't feel confident in your ability to lie on the fly, then you could try to proactively text her. Send a photo of mom, or a little update (e.g. nurse just brought mom such and such) when you ARE in the room, just often enough that your sister won't feel like she needs to check up on you.
posted by phunniemee at 2:33 PM on October 5, 2022 [27 favorites]

I'd go for the white lie myself. Objectively I don't know if your presence actually does anything so taking a break every so often would be fine by me.
posted by any portmanteau in a storm at 2:35 PM on October 5, 2022 [1 favorite]

Your sister is not your boss and she's not the boss of how anyone spends time next to a bedside. You get to be with your mom in the way that works for you, and that includes not reporting in to your sister or telling her details that are none of her business. This is about you and your mom, only.
posted by Ink-stained wretch at 2:48 PM on October 5, 2022 [15 favorites]

A white lie is fine. You sister is managing her stress by making everyone around her miserable. It's unhealthy and not appropriate and you are not obligated to add more fuel to her fire. Do your visits your way and she doesn't need to know details that she'd only use against you and everyone else. Find your own way to be a calming presence in your mom's room instead of being a stress ball and that's the best thing you can do right now.
posted by quince at 2:49 PM on October 5, 2022 [9 favorites]

Best answer: don't tell her.

are you afraid something is going to happen right when you aren't in the room and then she'll ask you why you weren't there? you dozed off.
posted by fingersandtoes at 2:50 PM on October 5, 2022 [7 favorites]

Best way to avoid drama is to just say sorry if she comes at you. Sorry sis. (I know this because sometimes I get a lil high strung at my brother, and it's always a relief when he just lets that go.)
posted by bleep at 2:51 PM on October 5, 2022

Best answer: You are completely fine taking breaks, leaving for short periods to eat or make phone calls or sleep or whatever. your sister is not your boss and you do not have to make a full accounting of each quarter-hour to her.

but your sister is not just neurotic or overbearing or having an intensely controlling stress reaction or whatever else people may be tempted to accuse her of. she cannot require you to be hyperattentive but she is not crazy to be that way herself. Whether or not your mother will be able to recover to some extent, it sounds like right now she is fully unable to advocate for herself in any way. so if her children don't watch and ask questions and verify schedules and doses and procedures and the rest of it, nobody will.

and hospital staff are not monsters who pounce on the unprotected and helpless, but they treat patients better 1. when they know there are or might be witnesses, and 2. when they have direct contact with family members and thus know that somebody will raise hell if mistakes are made. yes, even if they think those family members are entitled and unbearable. perhaps especially then. so no, you don't have to hover over the nurses every second and make them hate you. but also, no, it isn't necessarily a terrible thing that your sister is doing that.

but one of her is enough.

(p.s. if by "rescue" you mean force the doctors to violate her DNR, everything changes. in that case you do want to be there as close to round-the-clock as you can bear to be, in place of your sister, to advocate for your mother's known wishes and protect her from this violation. but that may not be what you mean.)
posted by queenofbithynia at 2:51 PM on October 5, 2022 [28 favorites]

This internet stranger thinks your sister is being unreasonable, and suggests testing out the various toilets throughout the hospital.
posted by oceano at 2:56 PM on October 5, 2022 [3 favorites]

Perfectly reasonable white lie.

Sounds like she's coping with this via this rigidness, anxiety, lashing out - best I think to isolate yourself from that without provoking any unnecessary conflict.
posted by lookoutbelow at 3:09 PM on October 5, 2022

Best answer: Okay, so say your sister finds out you left the room for 146 seconds at 3am and freaks out: yap yap yap blah blah blah I'm an anxious controlling person who can't manage my own feelings bark bark yip.

You: *shrug*

Her: blah blah blah

You: I guess we just disagree on how to handle this situation, sorry.

Her: *unable to get the fight she wants, grasping at straws*

You: *shrug*

You will survive if she gets mad. She can be drama, you do not have to play. You are a grownup and you have your own understanding of what your presence there is for and the realistic extent of what you can accomplish. Unless there is a very dedicated serial killer on the floor, you staying in the general area and checking in a couple times an hour is sufficient to the task at hand.

You just need to rehearse the art of not taking her bait. You can be internally upset by it but you can bite back any responses and replace them with a shrug. If you need to go scream into a pillow after she's left the area that's fine, but you may find after a couple of these that your body actually starts to adjust to this idea of being an adult with agency and common sense confronting someone who is being irrational because they are stressed and just kinda feeling an irritated empathy for her inability to self-regulate. It can't be fun to live like that, for her as much as for the people around her.
posted by Lyn Never at 3:10 PM on October 5, 2022 [15 favorites]

Response by poster: I don't know how she would know if I didn't stay in the room the whole time. I just know she can be a lot in a hospital environment. (As in we used to wonder if she was hovering around a Munchausen by proxy scenario without the intentional injuring of the patient.)

I would not put anything past her and want to proactively avoid any extra stress.

I love the idea to pepper her with proof of my presence when I'm there so she will leave me tf alone otherwise. Thanks.

Yes she is a lot and yes sometimes patients do really need that if they cannot advocate for themselves but it's sometimes hard to know whether she's doing appropriate work or looking for opportunities to prevent past traumas that are still ghosts in her closet.
posted by crunchy potato at 3:27 PM on October 5, 2022 [2 favorites]

Oh also you probably should not say this out loud, but honestly you're not interfering in HER method of dealing with this even though you personally may think she's going to enrage and upset the staff so much they're going to screw something up, so maybe she can just butt out of YOUR way of keeping an eye on things without manufacturing a bunch of extra tension among the night crew.

You can think this very, very hard though.
posted by Lyn Never at 3:27 PM on October 5, 2022 [2 favorites]

How would your sister find out unless you tell her?

I think sending her updates is an excellent way to forestall questions.

I assume she might make you promise to never leave the room and quiz you afterwards. And it maybe impossible to lie to her in her face. But what if you don't wait for her to ask you, but as soon as she comes back, before she can ask, volunteer whatever updates in minute detail, eg. mother became restless around 4am but night nurse came and did XYZ, bla blah etc.
Don't leave time for questions, as you finish with: sorry i gotta go now. Exit.

Re her checking in you by phone, could you turn it to silent or even off, and say the nurses asked you to so?
posted by 15L06 at 3:44 PM on October 5, 2022 [1 favorite]

Best answer: When I’ve been at a bedside my concern was always whether the person might die exactly when I left the room. Maybe that’s your sister’s fear?

Nobody can guess that with real accuracy but here are a couple of principles that might help:

1. I know a palliative nurse who says their general rule of thumb is that the patient’s remaining time can sort-of be predicted by their rate of decline. If they seem to get worse over the course of a month they’ll likely live a length of time measurable in months. If they seem to get worse over the course of a week they’ll likely live a length of time measurable in weeks. If they seem to get worse over the course of a day they’ll likely live a length of time measurable in days. If they seem to get worse over the course of an hour they’ll likely live a length of time measurable in hours. It’s not a hard and fast rule, but it can help.

2. One sign of impending end of life is called Cheyne-stokes breathing- you could look it up so you know if you see that sign, stay closer.

3. You could decide together to tell the person what you need to tell them, make your peace, and say goodbye. You could tell them, aloud, how you feel about them, resolve any issues, thank them, etc. You could even say something like, “I know you’re in pain and I want you to know, it’s ok for you to go. We will be ok. We are so grateful for the time we’ve had with you; we forgive you for —, and we love you. Thank you for being here for us. Now we will be here for each other, and take care of everything. You have nothing to worry about, just feel peace. You have lived a beautiful life. When you’re ready to go, know that we love you, and it’s ok.” Once those things have been said, leaving for a coffee stops feeling so risky. The person knows it’s safe to go so if they die while they’re alone, it can feel like they chose to go when they’re alone. It really helps alleviate guilt to say that stuff early on. And if the person recovers from this crisis, even better- it’s win win no matter what happens.

Maybe if you can help your sister reach this peace and say goodbye, she can let go a little bit? Either way it might be helpful for you to do it for yourself. Whenever I’ve said a real goodbye at the bedside in my life, it’s helped a lot.

Bedsides are hard- wishing you all the best.
posted by nouvelle-personne at 4:10 PM on October 5, 2022 [31 favorites]

As a bedside med/surg and then ICU nurse for many years I can tell you that your sister has not made friends of the staff by scrutinizing how they are doing things. We bedside nurses loved family that was actually friendly and helpful (simple things like fluffing a pillow, putting blankets on or off, etc.) as this often made their ill family member feel more secure and loved. It's difficult, if not impossible for a nurse to respond in 15 seconds to a beeping pump or rung bell. It does take a couple of minutes for a nurse to respond unless there is an emergency, and we need to prioritize. If a patient in another room is getting out of bed to a commode for the first time since surgery, for example, I need to stay with that patient until she is stable.

But I know that it's very hard for some family members to trust the nursing staff. We do rotate days and shifts, and some family members BADLY NEED to feel like they are in control - or they will feel completely out of control. But perceived criticism or hostility will not result in a happy hospital stay, or better care, since the staff will tend to reduce their interactions with the patient and visitor to the minimum.

From my perspective the best family treated us like they were part of the team. They told us things about your family member we would have no way of knowing, like what kind of person she is, what she loves, what she hates, funny memories, and other vignettes that can personalize your mom to me. I, too, love caring for people I feel some connection with. That's why I'm not in a cube doing statistical modeling; I'm at a patient's bedside wiping up their messes, voluntarily.

The best family members were observant and told me things like "Her nurse yesterday commented that she seems to like facing the window" or "She really loves this body lotion. Can you use it when you bathe her?" or maybe "I made a playlist of music she loves. Can you play it when I'm not here?"

I think you should focus on your mom rather than your sister, and do what your heart tells you your mom would want, and what you want at this crisis time in all your lives. My best wishes for you and your family.
posted by citygirl at 4:11 PM on October 5, 2022 [50 favorites]

Most hospitals that I have been in recently have a white board in the room. You could write a note on the white board that says "Family member staying at the hospital tonight. [phone number] [your name] [relationship]." and then mention to the CNA and nurse when they are in the room letting them know that you've stepped out, this is how they can reach you. This gives the staff an easy way to get in touch if there is there is something happening where they would want to tell you/ask you (eg. consent for a medical treatment, confirmation of the DNA, observation that death is very near) and wonder where you have done off to. Now, I absolutely wouldn't count on it - lots of reasons why a phone call wouldn't happen when you would have wished that it did - but it might give you some comfort when you are away. Just be sure to erase it before anyone else in the family shows up.
posted by metahawk at 4:44 PM on October 5, 2022 [5 favorites]

All of the above advice is good, but I think you need a strategy for detaching yourself from sister drama if/when your sister behaves the way you know she will at some point.

I’m assuming that there will be some point at which you may not be able to completely avoid her. And it’s not reasonable to expect her to change suddenly while under duress. Can you pre-decide that your parent is what’s important now and to give your sister some grace for being especially…herself at this time? I know that if I’m prepared for someone to trigger me I can avoid going over the edge.

Sorry you’re dealing with this.
posted by kapers at 5:13 PM on October 5, 2022 [1 favorite]

If you feel you need to tell white lies, that's one option, but it isn't sustainable. Better to just tell her upfront that you're doing it your way, and that's that. Take control. Draw that boundary. Seriously, what is she going to do? You are both adults.
posted by computech_apolloniajames at 5:54 PM on October 5, 2022 [2 favorites]

Best answer: Right now, in most of North America, nurses are working at high and often unsafe staffing ratios. So where maybe a couple of years ago, there would be 1 nurse for 2-3 patients in a particular department, it’s 1 nurse for like 5-6. They’re overwhelmed. As well, now they are frequently inexperienced new graduates, or “travelling” nurses who are new to that department.

All this means that care is likely to be compromised, things are now more likely to go forgotten or missed unless there’s a squeaky wheel.

If your mom’s cognition is compromised, she can’t do that for herself. She may not be able to even answer basic questions. With many nurses given not enough time to do their jobs, they might eg ask her if she’s in pain, but your mom might need to be asked several times or in a particular way to understand.

Other things that can go missed - did your mom have a bowel movement in the past three days, if not that could add new trouble (like a perforated colon) to her existing trouble. If she can’t report this to nursing staff herself, someone’s got to. Maybe someone will pass her a tray of food, but maybe she won’t touch it unless someone sits with her and encourages her to eat. Maybe, the nurse will be so busy the fact that your mom didn’t eat will escape her notice. Lots of things like that that she can’t report, you can’t. Adverse effects from a procedure or medication, unsteadiness on her feet… nursing staff want to be positioned to observe these things but in many hospitals these days it is just impossible.

Information gets lost across shifts. Sometimes you have to repeat information to multiple people to ensure it gets where it needs to go.

Tldr: your mom’s mental status + more or less the slow collapse of the healthcare system = truly, someone needs to be her eyes, ears and mouth. Watching and reporting and advocating. (And sometimes helping, sometimes nurses are grateful for the extra help.)

For sure go to the bathroom and eat, but yeah, go back. If all is well and she’s ok, read, watch a movie on a tablet. As well - sometimes the hospital can hire a sitter if it’s called for (often is with dementia patients). Not sure if families can hire their own sitters outside of hospital processes but you can ask about it. It would be a trained personal support worker who’s gone through a background check, you can ask them to attend to extra things. Ask your mom’s nurse about it.
posted by cotton dress sock at 9:28 PM on October 5, 2022 [5 favorites]

Possibly too much information about dying below. Yet it might be helpful to you.

When my father was dying and in palliative care, i had a similar situation to yours with your sister , with my father's second wife.
She actually had a bed in his room and basically lived there (room had an en suite bathroom) for the weeks until he passend. Because i hated her and abhorred visiting with my father (who was comatose) while she was in the room a mutual friend convinced her to take a two hour break each day, and i promised to sit with him during that time which was fine for me i did not want more and if on some days one hour was all i could manage she never knew, no one told her when she returned the nurses would only say that i had already left but not when. If on the next day she was there when i arrived i would start to talk before she could ask.

All this just to give a back ground to what maybe helpful to you.

Second wife's biggest fear was that my father would pass while she was gone.
And this is exactly what happened at the end of the third week. He died in my arms while she was gone. It was an exceptional and deeply moving, peaceful experience, which i prefer not to describe here, and nurses only came to check if i was okay and took over once he was dead.
Nurses had called second wife, but she was not back in time and he had died before she came back.
She was fantastically upset and angry with me and the nurses, accusing me and nurses of engineering that she would be too late. Tbh i never thought of her while was in the process of dying. The nurse however did call her yet he was dead before she arrived.

Later one of the doctor's explained to me that this was actually quite common, that the person dies once the person who has difficulty letting go leaves the room.
So if this happens, or even she Passes while you are walking the corridors, don't feel bad. Don't let anyone blame you.
posted by 15L06 at 6:49 AM on October 6, 2022 [10 favorites]