Monday, 6 May 2013

A cultural divide that needed bridging



One day as I made one of my regular visits to the ICU I was told of the very sad situation of a 38 year old woman who collapsed in the street. Her breathing and heart stopped during the collapse. The paramedics managed to resuscitate her but once in hospital they realised that she had massive brain damage and was unlikely to survive. She was not married and her parents were on their way from abroad. Once the parents arrived I met with them on several occasions. They were obviously distraught and I spent lots of time just listening to the mum sob. It was an awful situation for everyone.

The young woman was moved from ICU to a ward and everyone knew it was only a matter of time. The palliative care team had become involved and had written up medication to help with the fitting that was occurring as well as the usual end of life medications.
The young woman’s dad was a very contained man and didn’t say much. The mum opened up to me more. They were always very polite and appreciative of my visits to them and their daughter.

The young woman died in the early hours one day. I became aware of this when I bumped into one of my palliative care colleagues in the hall. She told me that the parents had been unhappy the last day about medication and it seems there was a problem with the ward not necessarily following the instructions given by the palliative care team. I am well aware of the difficulties that can arise due to communication not being carried out effectively and kind of inwardly sighed at this added difficulty. I said I would ring the parents the next day to give them a bit of space from the awful immediacy of their daughter’s death.

Much later that day after most people had gone home my palliative care colleague phoned me. She said “Thank God you are still there” She sounded really shaken up. The woman’s mother had phoned her and screamed and shouted and sworn at her almost hysterically for half and hour. It seems she was holding my colleague responsible for her daughter not having a peaceful death. The mother would not accept from my colleague that she had written up all the medication that her daughter might possibly need and that there was nothing further that could have been done.

I really felt for my colleague. It is extremely hard to have all that raw emotion aimed and thrown at you and still keep a professional view of the situation. My colleague had started to doubt herself. I was able to reassure her that she had done everything possible. We then talked about this being an extreme grief reaction and then did a debrief. I told my colleague that I would ring the family and do any follow up needed. She warned me not to ring that night. I told her not to worry and to go home and have a nice glass of wine and that I would ring her and the family the next morning.

When I spoke to the family they were obviously distressed but were calm and coherent. It seems my colleague had born the brunt of it and they were now able to be rational again. I offered the family on-going support and said that if they needed any advice to let me know. I was acutely aware that they were not in their own culture or familiar surrounding. I also know the death is a bureaucratic nightmare. I encouraged them to ring me at anytime and said I would also ring them from time to time.

I didn’t hear from them for a few days and by the time I got to ring about a week had gone by. They told me they had arranged their daughter’s funeral for the next day and said I was welcome to come if I wanted. I asked them who was taking the service for them. They said no-one that they had just invited all her friends and hoped they would all say a few words. My stomached flipped as they said this. British funerals just don’t work that way. I said I would come to the funeral and that I’d see them in the morning. I then desperately searched for a few meaningful poems before I had to dash from the office for a meeting.

The next morning the woman’s friends gathered at the crematorium. The parents said a few words about their daughter at the beginning and thanked everyone for coming. Her dad then told us about the kind of child this young woman had been and how proud he was of his daughter’s achievements. He then said if anyone else wanted to say anything he’d like to hear from them. There was an uncomfortable silence. I got up and explained who I was. I read a poem and then said that we weren’t used to getting up and talking at a funeral but it’s good to have the opportunity to say a few words about the person who had died and what they meant to us and share memories. I sat down then a man got up and spoke about his debates with the young woman and how they always laughed together. He sat down and then there was the uncomfortable silence again. Eventually the dad got up and said he didn’t know what else he could say but that his daughter was the best person she could be. He started to choke on his tears so I went and stood beside him. He gratefully glanced at me and went and sat down. I read another poem and said people might like to share their thoughts with those around them. Again there was an uncomfortable silence. This time the mum got up and thanked everyone for coming and asked me if I would say a prayer and finish the service.

I normally think about what I am going to say for a week at a funeral. I take longer to prepare for funerals than for sermons because I think it is so important to give someone a good send off. Here I was, standing in front of everyone, with no notes and only a few moments notice of having to say something. I think what I eventually said was appreciated and I was fortunate to be able to recall words that I have used in similar circumstances but I didn’t like it and the experience left me exhausted.

The family came to see me a few days later. They left me a card which had these words inside; “We’d like to thank you for all of your help and support – it was a real comfort to us. While we thought we could ‘go it alone’ your presence at our daughter’s funeral aided us so much in getting through a most difficult time. We wish you a happy and fulfilling future. We’re sure that your compassion and understanding will continue to help many people. We hope that you derive much personal fulfilment and satisfaction for all do for others. You are a truly special and compassionate person.
The enclosed is for you to do with as you wish – charities, etc. it is a very small token of our appreciation”

Inside the card was £100. Sometimes it is impossible to gauge the impact of an interaction and what different people take away from these tragic situations. I will treasure this families comments and feedback. The money I gave to our chaplaincy fund from which we do an annual memorial service for all those who have died in the hospital. I wrote to the family and thanked them and said I would remember their daughter at the memorial service even though by then they would have returned to their home country.

No comments:

Post a Comment