Read on Twitter
The last thing I did before leaving at the end of my overnight shift this morning was call the father of a 20's patient who died in an MVC overnight. It was an awful way to end & a reminder of what is definitely the hardest part of my job.
Giving loved ones the news of a death is always hard but when the deceased was young and the death was unexpected it is particularly emotional. I dread those calls or times in the family room and yet I approach them with great responsibility and gravity.
I always envision how the lives of those that I will give this news to will change forever when I say the words 'I'm so sorry...' and how that moment will be etched in their minds. They will not remember me if I do my job well so what I say and how I say it is so important
I have seen this done well by many and not so well by some and over the years have made my own way of handling this moment and want to share with those who are in training or earlier in their careers and may still be unsure how to do it with grace.
I offer this not as the one best way to give this news and stay whole but rather as one EPs experience. I welcome others to add their own thoughts. 1) Environment-In person is always best and having a private room to meet with family allows for people to express emotion
If you must call, make sure the person on the other end is not driving. If they are ask them to call you back when they have pulled off or parked. Call from a quiet place and ensure that they have your number and can call back in case the call drops
2) People-Except in unusual circumstances allow everyone who wants to be there to be there including younger children. I have found that children want to hear this information and are often the best at comforting others. Have a social worker or chaplain present to offer support
3) Introduce yourself and other professionals-make sure you make eye contact and introduce yourself to everyone in the room. 4) Ask what they already know-This is the most useful part of setting the stage for what comes next.
If the family already knowns that the patient had a cardiac arrest or was shot then you do not need to waste time going over details that will only heighten anxiety and tension. If they are unaware as what went on, give a very brief and succinct synopsis.
Do not get in to details, there will be time for that later. Right now they want to know the end of the story not the middle. 5) Be brief and do not use euphemisms-be very plain in your language. this is not the time for 'he/she has passed' or 'we could not resuscitate him/her'
Once you say 'I'm so sorry...' they will know the rest but always express that you ARE sorry. 6) Allow emotion-families react in many ways and when the patient was young, the sudden emotional response can be dramatic and overwhelming.
There is no easy way to handle this or be unaffected. I always make myself available by laying my hand on an arm or shoulder, or providing a comforting embrace if initiated by the family member. I cry with them because I am as affected as they are.
7) Allow for questions and be available- I always conclude these conversations by asking the family if they have any questions about what went on. If appropriate I offer them visitation before the body is moved (check with nurses first)
In the moment family will be shocked and may not think of things immediately so I always tell them how they can reach me if they think of things later and I ensure that I am available if they do follow up.
Finally, I ask if there is anyone else that they would like me to speak to who is not present and if so I make that call. I always end with again expressing my sincere condolences and expressions of sympathy.
These exchanges are very difficult but they can be rewarding. I always try to imagine that these people will think back to the worst moment of their lives and remember a kind physician who spoke to them plainly and empathetically and hope that this will dull the pain
Do not underestimate how these conversations can affect you. I remember many that I have had over the years as thought they were yesterday. I carry that grief with me always.
Make sure that you have a way to process those emotions in a healthy way and know that it is ok if you have difficulty doing so. There are resources to help whenever you feel overwhelmed by this or any other part of our job-take advantage of them
Being an emergency physician has many challenges and that for me is why I find this career so rewarding. Delivering this kind of tragic news is something that we all dread but if done well can have as much of a lasting impact on our patients' families as if we had saved them
