“What about the wife?” the social worker asked.
How could we have missed this most basic and vital piece of information? It’s easier than you might think. The sister didn’t get along with the wife and apparently wasn’t moved to tell us of her existence. The social worker had been out sick, and his replacement assumed that we knew. And we had a concerned sibling at the bedside who fulfilled our mental checkbox for who makes an acceptable surrogate decision-maker.
While doctors are dealing with the medical issues during end-of-life situations, they have a harder time thinking about the personal wishes of their patients. It's best to have a plan in place and someone to communicate those wishes to the doctor in charge.