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
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
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
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
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
I believe that
with appropriate effort and education, physicians
can become as adept at psychosocial healing as
we are with clinical entities.
by The American Academy of Experts in Traumatic