A sick woman came into the ER. She was in her mid-fifties, battling some kind of cancer, but she wasn’t at the point where she expected to die. We told her the standard things we could do for her, but as time went on, we realized that she was much sicker than we first thought. The family agreed to let us put in a respiratory tube, but during the procedure, she actually coded and her heart stopped. We tried to revive her but were unable.
I was a resident, and it was my responsibility to tell the family what happened. No one was available to go with me, so I went in alone. This was a woman who walked in here, and three hours later, she was dead. Maybe we didn’t recognize how sick she was initially; maybe she needed to be intubated sooner. You start to doubt yourself and wonder what else you could have done to prevent this. I was dealing with my own emotions but also had to maintain my composure. There were a lot of people in the waiting room, generations within the same family—the children of the woman, her sisters, and her parents.
We’re taught to tell a family the bad news as straightforwardly and succinctly as possible—no technical mumbo jumbo. I told them that things had turned for the worse quickly. I wasn’t prepared for the family’s reaction. As soon as I said “Your mother has passed,” the screaming, yelling, and crying started. People were on the floor. People were running up and down the hallway. People were grabbing me, crying—“How could this happen, how could this happen? Are you sure she died? Is this a mistake? Is it somebody else?” I realized very quickly that there were no words of comfort that could make them feel better, that nothing I would say could really help. At that point, I had to shift gears. I told them I was very sorry, and that we would try to help them get through this. I felt a sense of helplessness and a sense of not being equipped or trained to deal with these things.
In medicine, you learn on the job and from past experiences. That’s just the way it’s done, unfortunately. In emergency medicine, things happen very quickly, you make decisions very fast, and often you don’t have a rapport with the family. They don’t know you from a hole in the wall; they don’t know your level of competence. To make it worse, you’ve told them that their loved one is probably going to be okay and then you’re telling them that their loved one is dead.
The family needed time and space to get their emotions out, but we couldn’t have people running up and down the hallways. I was trying to respect their needs but at the same time to protect the other patients’ space and privacy. I got help almost immediately, because everyone was aware that we needed to contain the situation. Security came to help, nurses, and a social worker to speak to the family. It was very hard, but we stuck to the message, that we were very sorry that this happened. It took about 25 minutes. Like I said, there was a feeling of guilt—could I have done something to prevent this person from dying? That was the first feeling. Eventually, my defense became, “This person had cancer, she was going to die anyway.” You build your own defense tools. It’s not my fault the family waited too long to bring the patient in. I did everything I could. I went through the emotions of self-preservation.
Some of the thoughts came afterward, when I was home decompressing. Medical training doesn’t teach you how to deal with these things. There’s no grieving process for the practitioner. Sometimes you talk to your colleagues. Doctors are supposed to be strong, stoic, and move on. Some fields deal with death more than others, and we all deal with it differently.