1. WB_Vasquez

    WB_Vasquez Member

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    Formal Death Research (dying at home)

    Discussion in 'Research' started by WB_Vasquez, Sep 5, 2017.

    At the beginning of my novel, one of my characters dies. She is in her home when she dies of what initially appears to be complications from her battle with cancer (she was bedridden and dying).

    Some information about her:
    -She's elderly
    -She has no health insurance
    -She has no POA or DNR
    -She does not have hospice care

    The character's family is in charge of providing care for her while she gets ready to die at home. Since she's reluctant to face death, she has made no preparations for her death. When her husband discovers her unresponsive, he calls 911 even though she's dead.

    In the U.S., would paramedics take her to the hospital or attempt to revive her even though she looks dead? If they did, would doctors perform any tests on her to determine the cause of her death?

    I'm asking because her cause of death is kind of a big deal. The character commits suicide by taking too many pain pills because she's sick of being in such pain all of the time. She's Catholic, so would that sort of death cause problems for her funeral and burial if it were to come to light? And if the character's hands were weak due to a combination of cancer and arthritis (in her fingers), would the doctor suspect that someone assisted her in overdosing (those pill bottles are hard to open)?

    I have parts of the scene written, but I can revise some of it for realism. Does anyone have experience with this? I worked in a nursing home and saw a lot of death, but all of my residents had DNRs so they were always just carted off to the funeral home after the nurse pronounced them dead. I don't know anything about what happens when someone with no plan dies.
     
  2. archer88i

    archer88i Banned Contributor

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    In my experience, doctors will tend toward a kind of don't ask, don't tell thing regarding suicide in terminal patients. Yes, it's nice to think that life is precious and that preservation of life is the highest, greatest kind of good, but doctors have to deal with a very ugly, painful reality, day in and day out, and reality kind of doesn't care about one's principles.

    There is a thing called a "slow code" that you might look up (and you may already have heard of it), which applies particularly to terminal patients who don't have a Do Not Resuscitate. That should bring up some articles that will help you to understand their viewpoint.

    Obviously, this doesn't apply to every doctor. But what I'm saying is that if you don't want this to be a plot point, you can probably get away with brushing it aside.

    Regarding the whole weak hands thing, I don't see that as relevant. My little sister (in her twenties) has a disease that renders her hands fairly useless occasionally and her solution is to just not tighten the pill bottle so much. It would be difficult to fault a caring relative for doing something that simple to help out. Another solution to the same thing might involve simply transferring the pills to a bottle that doesn't suck as much to open.
     
  3. WB_Vasquez

    WB_Vasquez Member

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    Thank you for your reply. The nature of the character's death is the inciting incident of the story, so it is at least a little bit important. Maybe not so important that I have to include everything, but I want her family to be aware that it wasn't technically the cancer that killed her. Another element that comes to light is that her son, who was over taking care of her at the time, assisted her in taking all of the pain pills she took.

    It's definitely okay that the medical professionals don't make a big deal out of it, but maybe I could just have the family suspect, due to the character's weakness and the fact that all of her medication was kept too far from her bed for her to have reached it alone. The whole novel is full of family drama, and everyone being mad at this poor guy for "killing" (their words, not mine) his mother would add to the turmoil.
     
  4. Homer Potvin

    Homer Potvin A tombstone hand and a graveyard mind Staff Supporter Contributor

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    My wife is a hospice nurse and deals with people dying at home every day. Once a patient is terminally ill there is no 911 or death investigation of any kind. My wife gets a call, goes to the house to pronounce death, fills out the official death certificate and that's it. The funeral home will pick up the body (unless, of course, they're doing a home burial, which is becoming more common these days... not sure if that's legal everywhere, but it is in NH). I know you mentioned that she does not have hospice care, but if she is under the care of a doctor who is prescribing medication it would be very unusual for her not be monitored by hospice or some other palliative care. And she would have to be on medicaid (or is it medicare?) to get her medication if she doesn't have insurance, so she would be in the system, so to speak.

    All that was according to my wife, but she said it wouldn't be unprecedented for your patient to "slip through the cracks." She also said that there's never a death investigation unless requested by a family manner and there're overt signs of foul play. Once you're declared "terminally ill" the authorities are no longer involved in the process unless something weird happens.

    ETA: I just noticed that you worked in a nursing home, so you might have known all of this already.
     
  5. WB_Vasquez

    WB_Vasquez Member

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    Would it be more likely to slip through the cracks if the patient was not a citizen, but had a green card instead? She would still need enough medical care to have pain medication prescribed to her, so maybe I should change the story to where the medical staff don't investigate at all, but the family notices later that almost a full bottle of pills is suddenly empty. It might be better for them to suspect among themselves.
     
  6. archer88i

    archer88i Banned Contributor

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    Is the story you're looking for here something like, "Catholic family despises younger relative because he sent granny to Hell?"

    A close friend of mine committed suicide in December and it was pretty much just entirely covered up, because he and his whole family were Catholic. I was actually pretty amazed. We spoke out loud of him taking his own life but, on all of Facebook, I don't think anyone ever wrote the word "suicide."

    If you run with it in that direction, you could generate a lot of hate for all parties involved by having most of the family just kind of say, "Oh, she just died," and then having one member screaming at the son and carrying on because she refuses to toe the line... You probably already have crap in mind for this.

    But in the end, what I'm saying is that you don't need to worry about the official aspects of this because it sounds to me like they aren't relevant to the story. All you really require is one suspicious aunt who doesn't know that being polite is more important than being right.
     
  7. WB_Vasquez

    WB_Vasquez Member

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    No, not really. The character that dies was devoutly Catholic. The rest of her family (husband, kids, etc) went to church, but they weren't as religious as her, more of a follow the leader type thing. Most of this family isn't concerned about heaven or hell, they just feel betrayed that one of their own assisted the mother in ending her life. Especially because he was secretive about it and let them all believe that she just died on her own. They're a bit of a "selfish" family, concerned more with their own pain and grief more than what their mother was facing, and what the assisting son was having to live with.

    This shouldn't suggest that I'm avoiding all jabs at religion in my story, because I'm not. There are quite a few themes involved in the family's dynamic that doesn't fit with Catholicism and the story contains a few jabs at faith (nothing horrible, but I am certainly not having my characters cater to the church). For example, there are several gay people in the family, and for one daughter, coming out helps her distance herself from church.
     

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