Tuesday, March 22, 2011

Hold A Hand

Our ER case manager and I recently walked out of the family room after having to tell an only-child that his 85 y.o. mother was critically ill. She was so ill, in fact, that she had required emergent intubation for her respiratory distress and was now being sedated and paralyzed. This allowed the ventilator to do all of her breathing, conserving this woman's body of some much needed energy. The patient's worsening circumstances had transpired over the past three hours at her nursing home prior to being transferred to us and, unfortunately, her son had been en route when his mother decompensated in our ER, circling the drain before our very eyes. Thus, he never got a chance to visit with her before her intubation.

As we left the family room to go back to the patient's room and continue medical management, the case manager and I walked in silence, affected by the situation at hand. I had tried to hold off this patient's intubation for a few minutes, hoping that her son might soon arrive to exchange a few words with his mother, but it didn't happen. Because the patient's living will had requested that she be a "full code" (my understanding was that she lived a fulfilling, independent life), all efforts would be employed in attempt to save her life and help her through this medical crisis. We had intubated her successfully and aggressively began her medical management.

Suddenly, the case manager stopped smack-dab in the middle of the hallway and spoke to me. "You are amazing in that room, do you know that?" I looked her in the eyes, trying to see if she had picked an inopportune moment to hassle me, to tease me the way that us ER co-workers sometimes do to lighten such heavy, burdensome moments.

She was being serious. "After introducing yourself and shaking this son's hand, you sat down on the couch beside him, touched his shoulder, introduced the rest of us, and asked him how he was doing before slowly, in words he could understand, explaining everything that had been done so far to save his mother's life."

"Yeah," I said, "so?"

She continued. "Did you not feel the tension in that room? And somehow, after you were done delivering the worst of the news, the room felt hopeful, at peace. You could see the son's face slowly accept the news you were giving him. You eased his worries by instilling that we were doing everything we can to help his mother, without falsely elevating his hopes."She paused here, taking in a deep breath. " You showed him that you cared."

"Doesn't everybody do this, though?" I said, knowing the answer before I finished asking.

The case manager laughed in a regretful, wistful kind of way. "Are you kidding? You would be appalled at some of the ways I've seen bad news delivered in that room. No introductions. No sitting down. Blurting out the bad news without any preparation to the family. Leaving without addressing any of the family's questions. Jim, you need to teach more doctors how to act and speak more appropriately in that room."

By now, we had started walking again and were standing outside of the patient's room. The son was going to be escorted back in just a few minutes.

Not one to gloat over getting a compliment, I walked back into the room and continued helping my senior resident with this patient's care. It was, once again, a thing of beauty to watch our team methodically go about each of their responsibilities and, as a result, we were soon rewarded with this patient's condition stabilizing. She was still very sick, but at least the son could now spend some time at her bedside. Which turned out to be a blessing as, in the end, this patient passed on that same evening.

Later on that night, at home, after tucking in my kids and a glass of wine in hand, I was giving much thought to our case manager's words. Just a few weeks prior, during a night shift, a nurse supervisor who had accompanied me in the family room spoke similar words to me when we were done. "The way you approach patients and their families is remarkable," she had said. I may have blushed, but her words were greatly appreciated and I viewed them as the ultimate compliment.

Why isn't everybody at their best, especially in that room? I thought to myself, though, becoming a little annoyed. When did medicine become so shifted to view patient's and their families as "its" and not as human beings, as "hes" and "shes"? When did we abandon learning patient's names and their life story? Of taking a little more time in their treatment room? When did compassion and kindness sneak out the window and rush, rush, rush sneak in. When did the the quantity of patients one treats replace the quality of care given to each individual patient, defining, in some peoples' eyes, a better physician?

Sadly, most of us in medicine know that answer. With the increasing struggles of our profession, from insurance cutbacks to legal threats, from hospital cuts of personnel to the shifting thought that patients' rights outstrip our own, medicine isn't the field it once was when I signed up for a career twenty years ago. Especially in the ER, it is now common for us to be 4-6 hours behind every day, patients now relying on us not only for emergent care but for treatment of their chronic illnesses as well as maintenance medications. Can you see the frustrations? This quantity has potential to impede on our quality, to cut into the time we spend with each patient and their family.

I recently gave an hour lecture to our residency physicians regarding kindness and compassion. I started it with a tragic video of 9/11, scenes playing out to Sarah McLachlan's "Arms Of An Angel." We then watched a synopsis of the Columbine tragedy before I started talking. There was nary a dry eye. "See this devastation, this grief, involved in such atrocious acts?" I asked the residents. "What makes this grief and loss any different from that which you will encounter in a patient's treatment room or our ER family room?" A dropping pin could be heard in the room. Grief is grief, I reiterated. Loss is loss. Death is death. Respect is necessary. Kindness and compassion are a must. Addressing such concerns, I assured the residents, is one of the most important jobs they will ever face. Put the time in and learn how to view this responsibility as a privilege and not a burden.

This lecture was never finished. Before my time was up, only half of the slides had been presented. Instead, we had spent a great deal of time talking about personal techniques on how to interact with patients and their families and how to deliver devastating news. My residents shared personal stories of their best and worst experiences. It was clearly evident that some of them were quite comfortable in their roles, while others struggled with this part of their jobs. This hour lecture on kindness and compassion had gone from the category of "light and fluffy" to receiving the respect it deserved. From the feedback of the residents, they were appreciative and definitely more cognizant of their roles in treating patients and their families.

As karma sometimes dictates, a few nights later, while reading Cutting For Stone, a brilliant fiction novel by a brilliant writer, Abraham Verghese (he who also happens to be a brilliant man of medicine), I happened upon a collection of words on page 519 that left me with goosebumps. In the novel, Dr. Thomas Stone, a leading liver transplant specialist, reads a letter from a mother of a trauma victim that he had treated. It follows:

Dr. Stone--

My son's terrible death is not something I will ever get over, but perhaps in time it will be less painful. But I cannot get over one image, a last image that could have been different. Before I was asked to leave the room in a very rough manner, I must tell you that I saw my son was terrified and there was no one who addressed his fear. The only person who tried was a nurse. She held my son's hand and said, "Don't worry, it will be all right." Everyone else ignored him. Sure, the doctors were busy with his body. It would have been merciful if he had been unconscious. They had important things to do. They cared only about his chest and belly. Not about the little boy who was in fear. Yes, he was a man, but at such a vulnerable moment, he was reduced to a little boy. I saw no sign of the slightest bit of human kindness. My son and I were irritants. Your team would have preferred for me to be gone and for him to be quiet. Eventually they got their wish. Dr. Stone, as head of surgery, perhaps as a parent yourself, do you not feel some obligation to have your staff comfort the patient? Would the patient not be better off with less anxiety, less fright? My son's last conscious memory will be of people ignoring him. My last memory of him will be of my little boy, watching in terror as his mother is escorted out of the room. It is the graven image I will carry to my own deathbed. The fact that people were attentive to his body does not compensate for their ignoring his being.

Brilliant. Simply and utterly brilliant. Thank you, Dr. Verghese.

We need to bring back kindness and compassion. We need to fix the medical field as it now exists so we can begin, again, to pay attention to that which is most import--the patient and their families. With kindness and compassion at the forefront.

Enough said.

As always, big thanks for reading. If you have had any experiences, either as a patient or as a family member sitting in that family room, that may enlighten us readers and make us better at what we do, please share...


Sharon said...

I also just finished "Cutting for Stone" and it's brilliant. I don't read a lot of novels but I picked this up because I had read Dr Verghese's other work. He's a terrific writer.

My hero is Dr. Ghosh -- he's everything a doctor and a human being should be. A real mensch.

Anonymous said...

*Tears* Thank you for what you do. I work in the home healthcare business, in the office.. but my heart appreciates the medical side also. Again, THANK YOU.

Anonymous said...

And you, my friend, have posted another brilliant piece of writing... Thank you for sharing such a deep, personal part of yourself with us, albeit within the confines of your profession.

Katie Axelson said...

Genuine affirmation, the kind that's hard to say but must be shared, can put a smile on one's face for days. Especially that coming from the right person at a strange moment. Most recently mine came from my campus minister as we walked side by side through a crowded airport. It also left me with a "Doesn't everyone?" feeling, the "I wasn't doing anything special" justification. But I've since decided that those are the best words of affirmation because they catch your true self. Everyone's quick to point out mistakes but he caught me doing something right and acknowledged it.

An administrative assistant here on campus has a very hard time remembering students' names. She said she was trained to forget them when she worked as an administrative assistant in a medical facility. Apparently that way if people asked her about patients her eyes recognizing the names would not give away confidential information. It made me so sad at the price we are willing to pay for confidentiality.

<>< Katie

John S. said...

Thank you for the great blog entry and for the nice mention of Dr. Verghese!

Mr Mobius said...

Sounds like your lecture would make an awesome podcast/video if you ever decided to record a version of it. I got 2 hours of teaching on 'breaking bad news' during an oncology placement in October, but it aimed itself at a very clinical and efficient 'step process', completely ignoring the humanity of the process.

I basically think that with a bit of empathy and common decency, bad news could be broken without a rigid stepwise progression.

Great article.

Anonymous said...

My brother died last year after a car accident. During surgery, something happened, and he came out of surgery brain dead.

The doctor told my mom he was brain dead, then he lifted my brother's arm and let it drop. Then he pulled open his eyes and shook his head violently. Then he said, "See? Brain dead!"

I don't even think my mom had asked "are you sure?"

Everything about his death is bad. But, that doctor just added a whole new bit of badness to it.

I wish that doctor would have taken your lecture before he met my mother.

Lynda Halliger Otvos (Lynda M O) said...

Back in ’80 I worked weekend nights in the ER with a young RN who had the ability to speak lovingly to families in a way that I have yet to see duplicated. A rare and needed skill in this profession.

I second the request for a podcast from you on this subject. Please, if you can find the time.

Empress Bee (of the high sea) said...

cutting for stone was a very good book doc and i love how you handled that son. we are very fortunate to have wonderful doctors but you never know when you may end up in a strange place with a strange doctor. this is the stuff they don't teach in schools, sadly.

thanks, bee

Hold my hand: a social worker's blog said...
This comment has been removed by the author.
Anonymous said...

There are doctors out there, like yourself, who care. I will never forget the kindness of my mother's cardiologist after she had the stroke that eventually killed her. I called his office to let them know that she was in the hospital, and that there was little hope of her survival. 20 minutes later this good man was in her room - greeting me with a long hug that I needed desperately. He spent almost 40 minutes with our family, reminiscing about my father, answering our questions, and just being there. Unbelievably, I never got a bill - he did this all out of the kindness of his heart. Thank you to him and to you for caring in addition to healing.

Anonymous said...

A few months ago, I was in emergency with pneumonia. A doctor turned to my wife and asked her, "Should we do everything to sustain him?" I now know from a newspaper article that this hospital now has a practice of "Advance medical planning" where a patient is likely to enter ICU but the bluntness of the question and that they asked my wife while I was fully conscious and rational annoys the hell out of me.

donna said...

You are incorrect in stating that the lecture was not finished. It was finished! God finished your
lecture his way. God used his blessed child, you, to better reach the attendees. You were his instrument and he was the conductor. You finished his synphony so his message of compassion was made. May this message be learned by many. God Bless and many graces heaped upon you!

Anonymous said...

Unfortunately, like the rest of the human race, not all doctors are nice people. Some didn't enter the profession to help people - they did it for power, status, and money. Not everyone is kind, unfortunately.

At one hospital, two elderly ladies shared a room. I was the close friend, and surrogate, for one. The other had her daughter there.

The roommates doctor was incredibly brutal. The woman was dying, her marrow had shut down. The daughter didn't understand. The doctor completely insulted her, told her that a kindergardener could see the condition of her mother, and with no medical explanation at all just told her to put her mother in hospice, and walked out of the room. A stranger, myself, had to comfort her. The nurse was appalled when she heard what had been said by that doctor.

In contrast, when my old lady friend crashed, the team was very good to me. No one tried to make me leave. When she was conscious, I held her hand. When she wasn't, I stepped back. Her last conscious memory was of me talking to her, and holding her hand. Which is how it should be.

They let me be part of the team trying to save her, rather than viewing me as an impediment. So at least my last memory of her is not a terrible one.

pam44 said...

My father just passed away Sunday morning. The staff of the hospital - the hospitalist, the nurses, the respiratory therapists - every single person were wonderful to both me and my father. The hospice workers were amazing. Everyone worked to make the end of his life as comfortable as possible for both of us. I cannot tell you how grateful I am.

Anonymous said...

I strongly believe that a person that is in control of themselves and not actively in the way should be allowed to stay in the room with their loved one. If death is near, please put yourself in your patient's and their family's place. This time is too important and cannot be regained once lost.

jimbo26 said...

Thank you Jim .

Angie said...

Two years ago, I was taken by helicopter in the middle of the night to the tertiary care center, intubated and utterly unaware that I was critically ill. My husband, toddler daughter, and mother had to wait in that room for hours without any indication of how things were going. Periodically a doctor or nurse would hurry in, ask some impatient questions, imply they were too stupid to answer correctly, then hurry out. Obviously, I am incredibly grateful to those same clinically talented doctors for saving my life. It would have been a huge help to my family, though, if there could be a social worker, nurse, or aide who could act as a liason from the treatment team to the family to help explain what was going on, what the doctors were doing, what to expect in the short and long term, and comfort them. It would be even better if that person could escort a family member to a window where they could see the doctors working -- if things aren't too gory. In my case, my family had to wait 6 hours to come in to see me, and my husband was never allowed to (with our bishop) give me a religious blessing of healing (that is very important to our faith) either in the ER or later in the ICU because the policy prohibited more than one visitor at once (our blessings require two people to administer) and bringing in the olive oil used to annoint the head of the sick was forbidden because it was "outside food". Of course, ensuring access to the patient by the medical team is paramount, but surely there was some moment in those long hours where my husband and bishop could lay their hands on my head for 2-5 minutes. Imagine how my husband would have felt if I had died and he hadn't been allowed to even try to do what he could for me. Within reason, allowing people to practice their rituals and observances can be very important for the survivors as well as the patient. This particular (public university) hospital would allow a Catholic priest to give Last Rites but not my Mormon husband to give me a blessing.

kate sweeten said...

I had to make a trip to the ER last week for what turned out to be appendicitis and fully intend on writing a letter to commend those (doctors and nurses) that went above and beyond to make my ER visit, surgery and hospital stay as pleasent and anxiety-free as possible. I'm sure they don't hear "thank you" enough and completely deserve to know what a difference they made in an otherwise scary and uncomfortable situation.

Thank you for what you do. More doctors should be like you.

Winking Doll said...

Thanks for yet another touching article. You're right, the health care profession has changed dramatically in the last 2 decades, even in Singapore -- no thanks to legal threats, personnel cuts, management by KPIs (which often won't include the hard to measure "caring touch"), patients' rights outstrip that of the medical professionals, and increasing awareness and abuse of such rights by patients and their next of kins.

Winking Doll said...

Sometimes I wonder why do I still chose to enter into this profession, especially when I am trained and have experience in a totally unrelated profession. Nevertheless, when I receive affirming feedback and recall that I have made a difference to some people's lives, I think it is somehow worth it.

Dr. J said...

I am a big believer in having the family in the room during the resuscitation, so they can be physically close to their loved one. I am a bit dismayed to see comments that relate to various hospital 'rules' that have prevented decent care for very ill patients.

'We will care for the patient', that is the one rule to rule them all. Any lesser rule that is in conflict with this meta rule should never be enforced.

Peter said...

Having great mentors like yourself goes a long way to setting the minds of inexperienced staff on the straight and narrow when it comes to handling delicate matters such as impending death and death with family and friends of patients.

Having said that, the first time is always the hardest and words such as, "I'm so sorry for your loss" don't always cut it with people.

Tender loving care (TLC) mixed with words that really matter truly helps those who need it the most.

Where are all the great mentors gone? Perhaps tired of repeated experiences such as in your article and a life time of rejected construstive criticism drives them away. Mores the pity.

Take Care,

Esther Paris said...

Eight years ago yesterday I lost my beloved brother to stroke. A one-and-done kind of stroke. His last conscious act on this earth, as he suffered the headache from Hades, was to help another person. He was just that kind of guy.

The person whom I remember the most was the Organ Donation liason. She so lovingly traced my brother's hand onto paper... tubes and monitors and all making his hand tracing lumpy. I cherish that hand tracing. Truly cherish it. Her simple act of kindness will stay with me forever.

My brother's last (albeit unconscious) act was to be a donor for both his kidneys and his liver.

Thank you for being a sensitive person and not letting your career stamp that out of your modus operandi. May you always be such a gem.

Holly said...

Kindness matters.

Karen said...

I think you should be cloned :)

Have Myelin? said...

Thank you for this.

I have issues to this day on how my daughter was treated before she died.

My son and I did not want all teaching doctors and interns to talk about her in front of her. We knew she could hear them. She would squeeze our hands when we asked her to. Doctors tried to tell us no, it's reflexes...yeah right.

We asked them to step out in the hall every single time they came and they acted like we wanted them to hike 10 miles. I started calling them the Queens of Sheba behind their backs. =)

Most of the residents/interns appear to understand my point of view but all the Queens of Sheba were directing their subjects so I don't think they will remember...

I also wish the triage doctor had not kept my daughter waiting all day as she crashed 3 hours after being admitted despite having a record of a prior admission only 3 weeks prior for the same problem. (pneumonia) Her friends said there were too many screaming toddlers with snotty noses.

PLUS, my mother arrived at the hospital 30 minutes after visiting hours...her flight was late. They would not let her see my daughter. None of us got to talk to her again. That haunts us. My mother was called in the middle of the night to come back. My son and I arrived the next morning to find her in multiple organ failure.

Visiting hours are not necessary IMO. I am sure families get in the way at times but I think ya'll should deal with it. This time, the hospital got in our way. My daughter crashed with no family at her bedside and my mother is now tormented with that memory.

I think it would do a lot of good to teach the art of compassion/grief in medical school. Most nurses have it down pat but the doctors...well, you're an exception. =)

Anyway, thanks for listening.

terri c said...

I was working a shift (chaplain) in a hospital and met a wonderful ED physician. Patient came in having something really bad going on with his heart. I prayed with and held the family in the hallway. Eventually the physician came to talk with the family and to explain what was wrong and why it wasn't fixable, and explain that the patient was dying even despite the chest compressions and medicines and etc. He spoke understandably and patiently and answered questions. The family gave permission to stop the resuscitation. The doctor asked, "Who needs to be in the room with him then?" The family members sorted themselves out and moved into the room with their loved one. The resuscitation continued until everyone was where they needed to be and touching the patient, and then the doctor very quietly directed the team to stop. Each member then very quietly left the room, and the patient had a peaceful death with all the family around holding both hands, stroking his face, etc. The physician remained silent in the corner until death happened, and later I found the physician in the family room meeting the family once more to answer questions and offer support. That's my fave ED physician.

Teresa said...

I wish you had been the doctor when my kids dad died. There had been a horrible accident while out hunting with my kids and after being found by search and rescue he had been life flighted to a hospital 100 miles from where the accident had happened so my kids (13 and 11) were driven there by relatives. I was on my way to the hospital but had 300 miles to drive. Unfortunately he died while being flown to the hospital. When they got there the kids were taken into a waiting room and sat there and waited. Finally a nurse came in and said, "Well, I guess the doctor can't make it so I'll have to tell you...He didn't make it." My kids will never forget that and it still tears me up to remember what they went through.

Anonymous said...

I haven't yet had to endure this in my own life, but I'm lucky enough that I get to teach others how to communicate. I work in pediatrics and there are a few of us (pediatricians, child life specialists, peds ID docs) that teach communication skills to medical students as they rotate through our department. It's so sad that they don't get this education anywhere else in medical school. I love teaching about "breaking bad news", whether that's "your loved one has died" or "your leg is broken". The students always come into that session feeling like they have no idea what to do and most leave feeling empowered. We use role-play and actual cases to illustrate how important a skill this is. It's perhaps more important than all the other garbage we learned in medical school.

Thanks for writing about your experience and thanks for teaching.

Anonymous said...

I have had an experience being a family member in the family room. It was when my father was in hospital recovering from a craniotomy to debulk some of the tumour in his frontal lobe.

It was the day he was to be discharged and we were supposed to receive the results of his biopsy. No one seemed to want to talk to us about what was going on at all, then a nurse came and gave us his discharge summary so I read it. It said that he was being referred to Oncology and I knew that meant he had cancer. Finding out by reading a discharge summary was very, very difficult. When we asked the nurse about it she said "You're not supposed to read the summary." Finally we put our foot down and a young doctor came to talk to us.

He clearly didn't have a lot of experience with giving bad news and never looked at me once, in fact I was seated at the other end of the room near the door. He just blurted it out, that Dad was going to die and never even introduced himself. He just was saying it over and over and over. Telling Dad all the things he couldn't do anymore; don't drive, don't exercise too much etc.

It was a terrible experience and I did not feel supported throughout it at all. On the other hand the oncology doctors we were referred to were brilliant and so caring. But I will never forget that experience.

She said...

It's funny. There are people in all professions who forget that their "cases" are actual human beings. Computer geeks forget the software they are coding exists for someone who needs it to do their job, and that creating it to serve them right is what matters. Teachers forget that their students aren't just The One Who Doesn't Pay Attention but are children who may be hungry, tired or sad.

Luckily there are people in all professions that never forget the human in the humanity. I always feel so lucky when I encounter one of them. They are what make our species great.

Jen M Warren said...

Thanks ER DOC for doing your job well. With all the testing going on with my husband Mark, and still no answers since August, I WISH we had experiences that you deliver. People are blessed because of what you pour into their lives. A heart moved by compassion and love in motion.... Take care and enjoy ! Cousin Jenny in VA

soulful sepulcher said...

I was phoned by a care facility that my 20something non verbal autistic disabled daughter was sent to an ER for becoming agitated at her care facility (where she no longer resides). I was horrified no one was with her in the ER when I got there, and worse is how she was found by me. Strapped to a gurney/bed, no clothes at all covered with a sheet, the lights off in the room and the attendent w a clip board 'monitoring' sitting in a chair in the hall.

I demanded to know why she was strapped to the bed, someone get her clothes....

and don't forget the dignity, human kindness and compassion that people in their most vulnerable times whether sick, or dying deserve and mostly expect from medical professionals.

Thank God I was there for her, because no one in the medical staff at that ER was, ---and incredibly I received a phone call 12 hours later from a social worker telling me my daughter was in the ER.

One nurse on a new shift that came in saw her and brought her scones, milk and a kind smile.

Alone in times of crisis inside ER's or hospitals is traumatic and speaks for itself what it does to patients whether they live or die.

Why there are any hospital or ER horror stories of 'alone without family in time of need' is incredible in itself.

Hold my hand: a social worker's blog said...

The letter brought tears to my eyes. I can't imagine that terrifying moment.

What a coincidence, one of my recent posts has some similarity to yours. A heart-touching experience with a terminal patient.

www.doris-socialworker. blogspot.com

Laura said...

As I was reading your story, I was reminded of the book Cutting For Stone, and when Dr. Stone's son stands up in the lecture hall and repeats his father's words from his text book about (paraphrasing) medical treatment administered to the ear being words of compassion. As a patient with chronic illness and mother of a child with chronic illness...this is exactly what makes one medical practitioner stand out from another... I believe that it is the words of kindness, the gentle compassionate touch on a shoulder, the listening ear of the physician and the eye to eye contact that have the potential to heal more than any medication or procedure ever can... it is the connection between human to human...the mutual respect that we all crave and deserve and is too often missing. But when it happens, it is sacred, and I am grateful.

Thank you so much for sharing your thoughts...and for teaching your students what it really means to be a physician, a healer.

Lisa said...

I will never forget my OB's voice when he called to tell me my mamogram looked suspicious. He was so kind and concerned. He set up my biopsy for the next day - with a doctor that he trusted, one that had performed biopsies on him. He, my plastic surgeon, my oncologist and my radiology oncologist were all incredible - each member of their staff making me feel important, like I mattered.

However, this was not the case for the doc that did the biopsy. When he got the pathology report after my mastectomy, he couldn't even be bothered to let me know what they were. He sent me to the oncologist, with the paper report in my hand (I didn't understand what it said). In all the times I had seen him, all he ever said was "Oh, you might have to do a little radiation, but that's it." Well, that isn't what the path report indicated. So when the oncologist started talking about chemo I was caught completely off guard. He thought the other doctor had explained everything to me. After he realized what was going on, he stopped, backed up and explained things.

Dr. Mongo Lloyd said...

I told you a while back about my bout with necrotizing fasciitis. One of the most painful things a person can go through. Even worse when a doctor doesn't beleive you're in "that much pain" and lets you sit in a hospital bed for three days before calling a surgeon, even though the vanco isn't working!

terri c said...

To Stephany, who wondered why folks were left alone in the ED--that is because cost control measures in many hospitals mean that there is no one on staff who can be with them or advocate for them. I have done some shifts in a hospital that does their very best but could probably use a full time chaplain for the ED alone--and budget will likely never allow for this. I have met some incredible MDs there including the one I wrote about above but there's no question the ED can be a cold and lonely and scary place. And I thank Dr J above who understands about families being with their loved ones if at all possible. And, to Angie, OF COURSE your bishop and husband should have been able to bless you and if I'd been there I'd have supported the request. So sorry to everyone who has had painful experiences... So many of us wish we could do more to make it better.