Reference no: EM133850290

Sam: The Death of a Father

Sam is 36 years old and has worked for a governmental agency since he graduated from college 12 years ago. Sam is married and has 4 sons (ages 2, 5, 8 and 10). He is very involved in his church, coaches his oldest son's soccer team, and volunteers two nights/month at a local homeless shelter.

Sam had been feeling "tired" for the past couple of months and last week noticed that his gums bled more than usual after flossing. He also experienced two episodes of epistaxis. He had not had a physical examination in 5 years, so decided to see his primary physician. Upon examination of Sam and reviewing lab work and a bone marrow biopsy, it was determined that Sam had acute myelogenous leukemia (AML). He was immediately sent to the oncology unit at the local hospital and began chemotherapy after a central line was placed. After the first induction of the chemotherapy regimen, it was found that there were still numerous blasts in Sam's bone marrow. Sam was re-inducted with chemotherapy. Following the second round, there were still blasts in the bone marrow. Unfortunately, Sam had inherent drug resistance to the chemotherapy. Other options of treatment were reviewed with Sam, but his condition was deteriorating quickly. Sam did not have an advance directive.

Sam's two older sons had requested to see their dad, as they had no contact with him since he began his chemotherapy over a month ago. All four children had experienced colds and coughs while their dad was in the hospital and their mother felt it would not be appropriate for the children to see their dad, since they were not well. In addition, Sam's wife was concerned that the children would be upset if they saw their father so ill. "Your dad will be home soon and will be as good as new," she said.

The following night after hearing that his leukemia had not been controlled with the chemotherapy, Sam began to have spontaneous bleeding from his mouth, nose, eyes, and rectum. He was diagnosed with disseminated intravascular coagulation (DIC). Unfortunately, Sam died very quickly, despite aggressive CPR.

Discussion Question:

1. You have called Sam's wife to come to the hospital immediately. Once she arrives, you and the physician tell her about Sam's death. How would you respond to the wife's grief? What aspects of this scenario might put this family at risk for Complicated Grief? How would you assess this?

2. How would you make sure the children's grief was identified? What symptoms of grief could the children exhibit based on their developmental stage? What interventions could you use for the children?

3. Sam had been in and out of the hospital for the past 10 weeks (mostly in). The staff had become fond of him and his wife. How would you deal with your own grief over this loss? What interventions might be helpful with the staff's grief?