I had a dramatic family meeting last night.  My patient, Yvonne, a young 40ish woman with metastatic breast cancer has been in our facility for pain management.  She’s getting ready to transition either back home or to a nursing home for the last weeks/months of her life.

She’s had a tough time, her 3 teenage kids don’t seem to be accepting of her decline. Since she’s been gone from home, 2 of them have dropped out of school.  She can’t be around to encourage them to go, to take care of them, to help them keep their paths straight.

I met with her kids separately, to make sure they understood how serious their mom’s cancer was. Also, to give them a chance to ask questions.  We then went back for a larger meeting. All of the patients brother’s and sisters and cousins came. About 25 people all circled around the room.  I knelt on the floor next to my patient.  I spoke to her, but for the benefit of everyone.  I explained where we were at in her disease, and what the options were for next.  All of the family voiced the desire to take care of her at home, ready to pitch in. As I wrapped up I said something like, “Now is the time as a family to be saying the things that need to be said”.

One of her brothers spoke up, “I just want to say, sis, I love you… and doc, thanks for everything”. Another sister started to tear up, “I have something to say too,”  I was really amazed, I hadn’t meant THIS moment was the time to say everything, but hey, the mood was there.  The sister kept choking up, “If ever we needed to be a family, it’s now”  People were amening and crying.  The sister was visibly having a hard time speaking, “What I have to say is…. our niece, kiki has died”  At this, screams erupted. People jumped up wailing, saying “What!, Why are you saying this? How can you say this in front of Yvonne” Pandemonium, as people ran down the hall crying, shouting, moaning and angry.  Yvonne sat, tears streaming, looking weak and shocked.  The sister making the announcement said to me, “Yvonne raised Kiki, she was a 4th child to her.  Kiki was only 12, she had cerebral palsy from birth, and her death had been sudden.”

What a way to make an announcement! You’d think there was a more subtle way to let someone know their child had died. After comforting my patient, I got up to leave… that meeting was defiantly over, with a big black exclamation point.