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As
Emergency Physicians, we are often faced with
treating patients in their dying moments. To
nonmedical people, it sounds as though this
would be stressful, but for those who chose
Emergency Medicine as a career, it usually is
not. We relish the opportunity to save a life
or rescue a patient from the jaws of death.
We are very good at performing
the split second yet complex decision-making
tasks during a resuscitation. We are ever ready
to utilize the skills we have honed during the
hours in the Operating Room or procedural labs.
Of those patients who arrive with any signs
of life or who suffer witnessed cardiac arrest
in the department, we do resuscitate a significant
number.
Now, before we start patting
ourselves on the back, we must ask, "How
do we fare with our other group of patients?"
What other group of patients, you might ask?
I am referring to that group of patients in
the waiting room that are spiritually and emotionally
linked to the patient dying in the resuscitation
room. Sometimes we fail to realize that the
friends and relatives attending are just as
much our patients as the one in the cardiac
or trauma room with all the IVs and tubes.
While the patient in the Emergency
Department may have undergone a transition from
clinical life to clinical death, the loved ones
in the waiting room may be embarking on a path
leading toward emotional and/or spiritual disaster.
Usually the more unexpected the death, the more
difficult it is for family members to receive
the news.
Our every interaction with
loved ones must be geared toward directing them
up the path of psychological healing instead
of allowing them to drift down the road of emotional
pain and suffering. This in no way implies attempting
to thwart the grieving process, for this is
an important step toward healing.
I have discovered some things
to be helpful in my encounters with family and
friends during the initial moments following
the death of their loved one.
1. Sit down. This will impart
that you are not in a hurry and that you intend
to communicate on their level.
2. Identify the spokesperson
of the family. This will usually be the spouse
but could be an elder child.
3. Speak directly to the spokesperson
with direct eye contact. It is important to
impart your sincerity and your understanding
of the seriousness of the situation.
4. Make sure to have a nurse
or social worker with you to help comfort the
family.
5. Review the events leading
up to the patients demise. (The family will
not hear anything else you say after the announcement
of death.)
6. Make sure friends and family
understand the patients clinical status upon
arrival to the Emergency Department. Many family
members and friends do not understand that if
CPR was in progress, the patients heart had
already stopped.
7. Explain what you did in
lay terms. Explain that CPR was done by pumping
on the chest in order to try to circulate blood.
Explain that you put a tube in the wind pipe
to help breathe for the patient. Explain that
you gave medication to try to get the heart
to start again.
8. Tell the family clearly
that the heart would not start again, and the
patient died. Do not use terms like "they
have left us" or "they have passed
on" or "they have expired" or
"they are no longer with us." These
phrases are too vague and many family members
will not know what you are trying to tell them.
Some family members may even think that you
are trying to be evasive.
9. Find a private room for
the family away from the waiting room where
you can speak candidly and the family can express
their emotions and concerns.
10. Offer clergy and/or counseling
services for all family members and friends.
I believe that with appropriate
effort and education, physicians can become
as adept at psychosocial healing as we are with
clinical entities.
©1999 by
The American Academy of Experts in Traumatic
Stress, Inc. |
