Life and Death Perspectives of an Emergency Physician
Leonard D. Hendricks, M.D., F.A.A.E.T.S.

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.