There are an infinite amount of ways that someone might cope with the final chapter of

their life and this is largely influenced by their past experiences and support system. In the

following interview of my mother she discusses being a caretaker to my grandmother until she

passed away a year ago. She first discussed some of the experiences my grandmother had in the

past in regards to her encounters with the hospital. My grandmother was born in the 1930s, so

the healthcare system was quite different when she was younger. She gave birth to 8 children,

all under anesthesia and requiring a week stay in the hospital. Her eldest child was born with

cerebral palsy, and when she asked the doctor what his impairments would be she was told her

would never walk or be able to live a functional life. The nature of my grandma was that she

would not be told what her son would not be able to do, and today he is a father and completely

independent. This stubbornness can be a positive characteristic but can also make working with

the health care system frustrating. Despite this attitude, my grandma was not unfamiliar with

going to the hospital, whether it be during my grandpas experience with cancer and passing

away or delivering communion to sick parishioners from her church. Despite her familiarity

with the hospital and health care system, she was very against being in the hospital herself.

The reason for my grandmas hospital visit was initially an elective surgery to remove a

bowel obstruction. She was having some pain in her intestines and upon going to the doctor she

was told that she had a small obstruction that could be removed laparoscopically. If this surgery

is never performed the patient would most likely face more serious issues down the road, so she

elected to have it done. Risks of bowel obstruction surgery include blood clots, infection,

respiratory issues, and several others (Boniface 2013). Unfortunately, many of these risks

became a reality which resulted in a several month long hospital stay.

 Over the course of grandmas time in the hospital, my mom was one of her main

caregivers. The fact that my mom works in the health care system as a dietician and that my dad

is also a doctor helped her a lot with understanding the diagnosis and why things were going

wrong. However, there still seemed to be several issues with communication, especially with

making sure that everyone in the family was aware of what was happening. Something that

stood out to my mom when asking her about the experience was that she felt technology in

health care was becoming a barrier to making a personal connection with the patient. She also

felt that my grandmas personality of being very stubborn and difficult at times was not helpful

to her in establishing relationships with nurses. It also didnt help that she had so many different

doctors and caretakers that there was really no consistency. Something that everyone felt helped

to make her seem like more of an individual was bringing in pictures of her with her

grandchildren, children and husband. Such a lengthy stay in the hospital made grandma seem

much more frail and defeated than she truly was as a woman. Toward the end, she was having

respiratory issues that caused her to be on a ventilator. Nurses felt that they were able to look at

all the pictures of her before her hospitalization and see what a large support system she had,

which gave them something to talk to her about though grandma was not able to talk back.

After a few months of being hospitalized, and having one complication after another,

grandma was finally stable enough for her to move into a nursing home. However, during this

time she had a respiratory issue and began to code, but she was very adamant that she did not

wish to be resuscitated. It was something she was at peace with, and the family respected her

wishes, even though they did not expect that to be the outcome. After grandma passed my mom

was in shock, because all along she had been hopeful for a recovery and had put in so much time

to be with her. She didnt feel that grandma had inadequate treatment, or that there was anything
more she could do but this was because she understood the risks. She mentioned that she

couldnt imagine being in a situation like they had been in with having no medical background or

family member to explain what was going on. When reflecting on the experience in regards to

the health care professionals that she came in contact with, there were no extreme feelings either

way. She explained that some nurses were just there to do their job and not make a personal

connection, but others went out of their way to make grandma a little more comfortable.

When discussing the Kubler-Ross stages of grief, I first asked about what grandma

seemed to have gone through during her hospital stay. It seemed that what stood out was the

anger, depression, and eventual acceptance that it might be her time. In a letter to the editor

written by Eugen Bannerman in response to Kubler-Ross and the stages of dying he described a

possible sixth stage as the stage of being angry at God for not letting you die (Kessler 2004).

This stage also appeared to be displayed by grandma, which at the time was difficult for my

mom and her siblings to understand. All along they were all so focused on her recovery and how

they could help her return to her previous life, but grandma would still bring up how at times she

felt ready to die. They felt that this stemmed from that fact that her husband had passed away a

few years prior, and they also thought she was being dramatic at the time. It was only after she

passed that my mom was able to realize that she shouldnt have discounted that acceptance of

death, and that it might have truly been her time.

I next approached the subject of how mom has dealt with the loss of her own mother, and

how the experience itself moved her through the stages of grief. She recalls her primary emotion

to be shock, because she had watched her mother go from very healthy and active to so frail in

such a short period of time. She had never doubted that her mom would recover from the

situation, and it was all a lot to process. The other emotion that came to mind was a feeling that
she was lucky to have spent to much time with her at the end. She lived a few hours away, so

before this time it was rare for them to see each other besides holidays and special events, though

they talked on the phone frequently. My mother is both a very religious and practical person, so

she never felt that she went through having any anger and she saw no use for bargaining. She

also said that she and her siblings did not feel any guilt for what had happened, because they all

did their best to make sure she had the best care and coordinated their schedules to always have

someone with her at the hospital. They also felt blessed to have known and discussed as a family

her end of life wishes. Despite what was said during the interview, I recall after the event that

she did have a period of depression for losing her mom, but now has moved into the stage of

acceptance. In the Kubler-Ross book On Death and Dying she describes the acceptance stage as

being able to once again plan your future and re-engage in daily life (Kubler-Ross 1993). I feel

that shortly after the incident this seemed like a struggle for her, but now she is able to opening

talk about her mother without being emotional and is able to fully engage in her previous life

activities.

Prior to conducting this interview, I was nervous that it would be something hard for my

mom to talk about. The entire time that my grandma was in the hospital I was beginning my first

semester of graduate school so I was not really involved. I felt that my mom tried not to bother

me with talking about it a lot, and I havent had a lot of detailed conversations about it following

grandmas death. I was worried that bringing it up would cause her to become emotional and

that wasnt something I wanted to be responsible for. However, when I asked her to do the

interview she was very open to it and willing to recount what had happened. I enjoyed learning

some things about my grandmas life that I hadnt known, and it almost seemed therapeutic for

my mom to talk about.

 I know that my mom is someone who very much likes to be in control of all situations,

which makes something so unexpected difficult for her. When I asked her what changed the

most about her perspective after the situation, she said that she is now more sensitive to those

who talk about dying. She has always been the type of person who wants to fix things, but a

situation like this made her realize that not everyone wants to be fixed, and that it isnt her

decision to make.

Something that I felt I was able to take away from the interview is the reminder that those

in the hospital, especially when it is for such a long period of time, are never at their best. I feel

that often times I will think of someone in the hospital as being so depressed and irritable and I

forget that this does not usually represent the person that they are. I always knew my grandma to

be such a strong, independent and selfless woman, but the way my mother described her didnt

sound like my grandma at all. I could imagine that many of the nurses who saw her would have

had a hard time knowing who she truly was if they didnt take the time to ask. Putting this in

perspective inspires me to never judge a patient before I find out what their story is, and talking

to my mom helped me to realize how much family members notice when their loved one is

receiving good care.

When interviewing my mom about her perceptions of health care I was interested to hear

her opinions because she herself works in the health care realm. She has been practicing for

several decades and has had her fair share of experiences personally with friends and family, and

something she has noticed a lot in the recent years is the evolution of technology. Through her

experience with grandmas hospital stay she felt that many of the health care workers would

hardly look away from their computer screen and note taking to pay any attention to the patient.

They were often so focused on their job, which could also have been related to understaffing at
the hospital, but it still made patients feel very dehumanized. This is something that somewhat

changed my perceptions that advances in health care technology is always a positive thing. After

reading Ben Number Ten I was convinced that the reasons for all the mistreatment and

desensitization of health care workers had to do with it being so dated. Hearing about some of

the current problems made me realize how important it will be to not let technology get in the

way of forming a personal connection with the patient I am working with.

Another take-away point that I will apply to my practice in the future is maintaining

constant communication with my patients. I do not believe that health care workers often realize

that their patient doesnt understand a treatment or what their situation entails, but that is often

the case. When talking to my mom about her experience, she said often times the doctors, nurses

or PTs would come in and do their job but neither the patient nor their family understood exactly

why things were done. I think it would be easy to forget that people who have not been

medically trained will typically have no background knowledge about anything going on in the

hospital. This experience has taught me that I should be explaining the significance of

everything I do just so the patient knows why they should continue to do what I ask. I also think

that understanding the patients baseline knowledge and adjusting to their learning style can help

build a trusting and constructive relationship.

After conducting this interview, reading Ben Number Ten, and learning about the stages

of grief I have learned a lot about the emotional aspect of being in the hospital and have been

given a lot of patient perspectives to think about. Being knowledgeable about how to treat

someones pathology is only part of PT and it also takes empathy and compassion to leave a

positive impression on your patient. This experience has taught me that I have two options: to

treat being a PT as merely a job and a way to make a living, or to make a positive and lasting
impression on every patient I come into contact with. I am confident that the well rounded

education I have received at the University of Cincinnati will allow me to be more than just a

physical therapist but someone who truly cares for each patient as an individual.
References

1. Boniface K. Bowel obstructions. In: Adams JG, ed. Emergency Medicine: Clinical
Essentials. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 40.
2. Kessler D: The extraordinary ordinary death of Elisabeth Kbler-Ross. Am J Hosp Palliat
Med. 2004; 21(6): 416.
3. Kubler-Ross, Elisabeth. On Death and Dying. New York: Collier Books, 1993. Print.