Table 4.

Sources of tension and conflict (Theme 3)

No.	Quotation	Subject	Relationship to Patient
1	But, it’s up to the patient to decide who they are going to trust … you’re not allowed to put a gun to his head and say “This is the way it has to be.” Yeah, so it’s up to the patient. The patient has to decide to trust.	Subject C, woman in her 60s	Bereaved wife of a man in his 80s who had been on peritoneal dialysis
2	It’s going to be a very difficult decision, when I know that she should at some point let go or do some of these things, and she has made it very clear that she is saying “No, you have to do everything.”	Subject A, woman in her 60s	Daughter of a woman in her 90s not on dialysis
3	Well it would be hard on me … not to have him put on a respirator, because I want my son on the respirator, because I want everything done for him that is possible, and if it fails, then you know I would have tried … if we don’t put him on that, he is going to go. I don’t know. I don’t know what I would do. I think I would ask them to put him on it. I really don’t know. That's one thing I don’t know. That would be so hard. Then I would call the family, his sisters and brothers. I know they all love each other and they would say “Put him on the respirator, mother.” I know that’s what they would say … That mother instinct kicks in. That’s your job.	Subject B, woman in her 80s	Mother of a man in his 60s not on dialysis
4	Several times he’s called a couple of doctors and he said “I’m the patient, you need to talk to me.” So, that’s really important, to talk to the patient … if they are confused, it's different … It’s harder if the doctor comes in and starts talking to me and not looking at him and he gets upset … He needs to be in full control.
5	Yeah. I have to reinterpret, trying to be as close as to what the doctor said as possible … so it’s her … decision, you know. And she’ll come back to me with “What do you think about that?” … and I always … try to give her input and … repeat … “this is what they say, this is what they say might happen … and so you need to decide.” So that I kind of reword whatever it is they were telling her. I try not to not put in too much. I’m not a doctor.	Subject A, woman in her 60s	Daughter of a woman in her 90s not on dialysis
6	She asked, “What are you going to do?” And he said “I’m going to kill myself.” So, of course, she reported it to someone at the VA, because that’s what you are supposed to do. And so since then he was very angry that she told them about that because they admitted him to the Psych ward … so he was very angry about that. He still is angry with her about that.	Subject E, woman in her 80s	Mother of a man in his 50s not on dialysis
7	Like his last appointment he had looked at me and said “I’m so glad you weren’t there.” Because he had a feeling that if I had heard the news that he heard while … there with him, I would have been upset and angry at him (Probe: why would you be angry at him?) Oh, because one of the doctor’s visits I went with him he had been telling me his kidney function was around 20%–25%. And so when we were talking to the doctor he said “Well, you’re down to 15%.” And I looked at him and said “How can that be? You were at 20–25%?” And so I asked the doctor what was the number at his last visit and he said … “Oh, 18%.” And I’m like, “what?” So yeah, basically he is lying and keeping things from me. So, it was not a good scene.	Subject I, woman in her 40s	Friend of man in his 40s not on dialysis

VA, Department of Veterans Affairs.